Closed-loop oxygen system in late preterm/term, ventilated infants with different severities of respiratory disease

Abstract

Aim: To evaluate closed-loop automated oxygen control (CLAC) in ventilated infants >33 weeks of gestation with different respiratory disease severities.

Methods: Infants were studied on two consecutive days for 6 h each day. They were randomised to receive standard care or standard care with CLAC (Oxygenie) first. Analyses were performed of the results of infants with or without an FiO₂ ≥ 0.3 and infants with congenital diaphragmatic hernia (CDH).

Results: Thirty-one infants with a median (IQR) gestational age of 37.9 (37.1-38.9) weeks were studied at a median postmenstrual age (IQR) of 38.9 (37.4-39.8) weeks. In infants with an FiO₂ ≥ 0.3 (n = 8), CLAC increased the time spent in target oxygen range (92-96%) by 61.6% (p = 0.018), whereas in infants with an FiO₂ < 0.3, the time in target was increased by 3.8% (p = 0.019). During CLAC, only infants with an FiO₂ ≥ 0.3 spent less time in hyperoxemia (SpO₂ > 96%) (p = 0.012) and hyperoxemic episodes were shorter (p = 0.012). In both groups, CLAC reduced the duration of desaturations (SpO₂ < 92%, p < 0.001). In CDH infants, CLAC increased the time spent in target oxygen range by 34% (p = 0.036) and the median duration of desaturations was reduced (p = 0.028).

Conclusion: CLAC may be more useful in infants with more severe respiratory distress.

Keywords: closed-loop automated oxygen delivery; congenital diaphragmatic hernia; term infant.