Automated Closed Loop Control of Inspired Oxygen Concentration

Oxygen therapy is extensively used in premature infants and adults with respiratory insufficiency. In the premature infant the goal during manual control of the F-IO2 is to maintain adequate oxygenation and to minimize the exposure to hypoxemia, hyperoxemia, and oxygen. However, this is frequently not achieved during routine care, which increases the risks of associated side effects affecting the eye, lungs, and central nervous system. In the adult the primary goal is to avoid hypoxemia, but conventional methods of oxygen supplementation may fall short during periods of increased demand. On the other hand, there are growing concerns related to unnecessarily high F-IO2 levels that increase the exposure to hyperoxemia and excessive oxygen use in settings where resources are limited. Systems for automated closed loop control of F-IO2 have been developed for use in neonates and adults. This paper will give an overview of the rationale for the development of these systems, present the evidence, and discuss important advantages and limitations.