Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants

Objective To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO(2)) in maintaining arterial oxygen saturation (SpO(2)) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants. Study design Eighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO(2) target ranges and then treated with automated FiO(2) (A-FiO(2)) and manual FiO(2) (M-FiO(2)) oxygen control for 24 hours each, in random sequence. Results The percent time within the target range was higher during A-FiO(2) compared with M-FiO(2) control. This effect was more pronounced in the lower SpO(2) target range (62 +/- 17% vs 54 +/- 16%, P < .001) than in the higher SpO(2) target range (62 +/- 17% vs 58 +/- 15%, P < .001). The percent time spent below the target or in hypoxemia (SpO(2) < 80%) was consistently reduced during A-FiO(2), independent of the target range. The time spent above the target range or at extreme hyperoxemia (SpO(2) > 98%) was only reduced during A-FiO(2) when targeting the lower SpO(2) range (89%-93%). These outcomes did not differ between infants on noninvasive and invasive respiratory support. Manual adjustments were significantly reduced during A-FiO(2) control. Conclusions A-FiO(2) control improved SpO(2) targeting across different SpO(2) ranges and reduced hypoxemia in preterm infants on noninvasive and invasive respiratory support.