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Published ahead of print on September 3, 2004, doi:10.1164/rccm.200407-929OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 10, November 2004, 1095-1100

A more recent version of this article appeared on November 15, 2004
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Submitted on July 18, 2004
Accepted on September 2, 2004

Automatic Control of the Inspired Oxygen Fraction in Preterm Infants. A Randomized Cross-over Trial

Michael S Urschitz1, Werner Horn2, Andreas Seyfang3, Antonella Hallenberger1, Tina Herberts4, Silvia Miksch3, Christian Popow5, Ingo Mueller-Hansen1, and Christian F Poets1*

1 Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany, 2 Department of Medical Cybernetics and Artificial Intelligence, Medical University Vienna, Vienna, Austria, 3 Institute of Software Technology and Interactive Systems, Vienna University of Technology, Vienna, Austria, 4 Department of Medical Biometry, Tuebingen University Hospital, Tuebingen, Germany, 5 Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria

* To whom correspondence should be addressed. E-mail: cfpoets{at}med.uni-tuebingen.de.

In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often time-consuming and inappropriate. We developed a system for automatic oxygen control and hypothesized that this system is more effective than routine manual oxygen control in maintaining target arterial oxygen saturation levels. We performed a randomized controlled cross-over clinical trial in 12 preterm infants receiving nasal continuous positive airway pressure and supplemental oxygen. Periods with automatic and routine manual oxygen control were compared to periods of optimal control by a fully dedicated person. The median (range) percentage of time with arterial oxygen saturation levels within target range (87-96%) was 81.7% (39.0-99.8) for routine manual oxygen control, 91.0% (41.4-99.3) for optimal control, and 90.5% (59.0-99.4) for automatic control (ANOVA: p=0.01). Pair-wise post-hoc comparisons revealed a statistically significant difference between automatic and routine manual oxygen control (Dunnett's test: p=0.02). The frequency of manual oxygen adjustments was lowest in automatic control (Friedman's test: p<0.001). Automatic oxygen control may optimize oxygen administration to preterm infants receiving nasal continuous positive airway pressure and reduce nursing time spent with oxygen control.
Key words: closed-loop oxygen control, continuous positive airway pressure, mechanical ventilation, neonatal lung disease, infants




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