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Automation of oxygen titration in preterm infants: current evidence and future challenges

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Dargaville, PA, Marshall, AP, McLeod, L, Salverda, HH, te Pas, AB and Gale, TJ ORCID: 0000-0003-0524-2642 2021 , 'Automation of oxygen titration in preterm infants: current evidence and future challenges' , Early Human Development, vol. 162 , pp. 1-6 , doi: 10.1016/j.earlhumdev.2021.105462.

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Abstract

For the preterm infant with respiratory insufficiency requiring supplemental oxygen, tight control of oxygen saturation (SpO2) is advocated, but difficult to achieve in practice. Automated control of oxygen delivery has emerged as a potential solution, with six control algorithms currently embedded in commercially-available respiratory support devices. To date, most clinical evaluations of these algorithms have been short-lived crossover studies, in which a benefit of automated over manual control of oxygen titration has been uniformly noted, along with a reduction in severe SpO2 deviations and need for manual FiO2 adjustments. A single non-randomised study has examined the effect of implementation of automated oxygen control with the CLiO2 algorithm as standard care for preterm infants; no clear benefits in relation to clinical outcomes were noted, although duration of mechanical ventilation was lessened. The results of randomised controlled trials are awaited. Beyond the gathering of evidence regarding a treatment effect, we contend that there is a need for a better understanding of the function of contemporary control algorithms under a range of clinical conditions, further exploration of techniques of adaptation to individualise algorithm performance, and a concerted effort to apply this technology in low resource settings in which the majority of preterm infants receive care. Attainment of these goals will be paramount in optimisation of oxygen therapy for preterm infants globally.

Item Type: Article
Authors/Creators:Dargaville, PA and Marshall, AP and McLeod, L and Salverda, HH and te Pas, AB and Gale, TJ
Keywords: infant preterm, oxygen therapy, oxygen saturation targeting, automation, control
Journal or Publication Title: Early Human Development
Publisher: Elsevier Sci Ireland Ltd
ISSN: 0378-3782
DOI / ID Number: 10.1016/j.earlhumdev.2021.105462
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© 2021 Elsevier B.V. All rights reserved.

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