ObjectiveTo compare the effect of two different automated oxygen control devices on time preterm infants spent in different oxygen saturation (SpO(2)) ranges during their entire stay in the... Show moreObjectiveTo compare the effect of two different automated oxygen control devices on time preterm infants spent in different oxygen saturation (SpO(2)) ranges during their entire stay in the neonatal intensive care unit (NICU). DesignRetrospective cohort study of prospectively collected data. SettingTertiary level neonatal unit in the Netherlands. PatientsPreterm infants (OxyGenie 75 infants, CLiO2 111 infants) born at 24-29 weeks' gestation receiving at least 72 hours of respiratory support between October 2015 and November 2020. InterventionsInspired oxygen concentration was titrated by the OxyGenie controller (SLE6000 ventilator) between February 2019 and November 2020 and the CLiO2 controller (AVEA ventilator) between October 2015 and December 2018 as standard of care. Main outcome measuresTime spent within SpO(2) target range (TR, 91-95% for either epoch) and other SpO(2) ranges. ResultsTime spent within the SpO(2) TR when receiving supplemental oxygen was higher during OxyGenie control (median 71.5 [IQR 64.6-77.0]% vs 51.3 [47.3-58.5]%, p<0.001). Infants under OxyGenie control spent less time in hypoxic and hyperoxic ranges (SpO(2)<80%: 0.7 [0.4-1.4]% vs 1.2 [0.7-2.3]%, p98%: 1.0 [0.5-2.4]% vs 4.0 [2.0-7.9]%, p<0.001). Both groups received a similar FiO(2) (29.5 [28.0-33.2]% vs 29.6 [27.7-32.1]%, p=not significant). ConclusionsOxygen saturation targeting was significantly different in the OxyGenie epoch in preterm infants, with less time in hypoxic and hyperoxic SpO(2) ranges during their stay in the NICU. Show less
Objective: To compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2). Design: Propensity score-matched retrospective observational study.... Show moreObjective: To compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2). Design: Propensity score-matched retrospective observational study. Setting: Tertiary-level neonatal unit in the Netherlands. Patients: Preterm infants (OxyGenie n=121, CLiO2 n=121) born between 24+0-29+6 weeks of gestation. Median (IQR) gestational age in the OxyGenie cohort was 28+3 (26+3.5-29+0) vs 27+5 (26+5-28+3) in the CLiO2 cohort, respectively 42% and 46% of infants were male and mean (SD) birth weight was 1034 (266) g vs 1022 (242) g. Interventions: Inspired oxygen was titrated by OxyGenie (SLE6000) or CLiO2 (AVEA) during respiratory support. Main outcome measures: Mortality, retinopathy of prematurity (ROP), bronchopulmonary dysplasia and necrotising enterocolitis. Results: Fewer infants in the OxyGenie group received laser coagulation for ROP (1 infant vs 10; risk ratio 0.1 (95% CI 0.0 to 0.7); p=0.008), and infants stayed shorter in the neonatal intensive care unit (NICU) (28 (95% CI 15 to 42) vs 40 (95% CI 25 to 61) days; median difference 13.5 days (95% CI 8.5 to 19.5); p<0.001). Infants in the OxyGenie group had fewer days on continuous positive airway pressure (8.4 (95% CI 4.8 to 19.8) days vs 16.7 (95% CI 6.3 to 31.1); p<0.001) and a significantly shorter days on invasive ventilation (0 (95% CI 0 to 4.2) days vs 2.1 (95% CI 0 to 8.4); p=0.012). There were no statistically significant differences in all other morbidities. Conclusions:In this propensity score-matched retrospective study, the OxyGenie epoch was associated with less morbidity when compared with the CLiO2 epoch. There were significantly fewer infants that received treatment for ROP, received less intensive respiratory support and, although there were more supplemental oxygen days, the duration of stay in the NICU was shorter. A larger study will have to replicate these findings.This study compared the outcomes of matched cohorts of preterm infants who were treated using 2 different automated oxygen controllers. Differences in morbidity were observed. The data suggest that it cannot be assumed that different automated controllers will produce similar results and that randomised controlled trials will be necessary to refine their use appropriately. Show less
Objective To compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2). Design Propensity score-matched retrospective observational study.... Show moreObjective To compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2). Design Propensity score-matched retrospective observational study. Setting Tertiary-level neonatal unit in the Netherlands. Patients Preterm infants (OxyGenie n=121, CLiO2 n=121) born between 24+0-29+6 weeks of gestation. Median (IQR) gestational age in the OxyGenie cohort was 28+3 (26+3.5-29+0) vs 27+5 (26+5-28+3) in the CLiO2 cohort, respectively 42% and 46% of infants were male and mean (SD) birth weight was 1034 (266) g vs 1022 (242) g. Interventions Inspired oxygen was titrated by OxyGenie (SLE6000) or CLiO2 (AVEA) during respiratory support. Main outcome measures Mortality, retinopathy of prematurity (ROP), bronchopulmonary dysplasia and necrotising enterocolitis. Results Fewer infants in the OxyGenie group received laser coagulation for ROP (1 infant vs 10; risk ratio 0.1 (95% CI 0.0 to 0.7); p=0.008), and infants stayed shorter in the neonatal intensive care unit (NICU) (28 (95% CI 15 to 42) vs 40 (95% CI 25 to 61) days; median difference 13.5 days (95% CI 8.5 to 19.5); p<0.001). Infants in the OxyGenie group had fewer days on continuous positive airway pressure (8.4 (95% CI 4.8 to 19.8) days vs 16.7 (95% CI 6.3 to 31.1); p<0.001) and a significantly shorter days on invasive ventilation (0 (95% CI 0 to 4.2) days vs 2.1 (95% CI 0 to 8.4); p=0.012). There were no statistically significant differences in all other morbidities. Conclusions In this propensity score-matched retrospective study, the OxyGenie epoch was associated with less morbidity when compared with the CLiO2 epoch. There were significantly fewer infants that received treatment for ROP, received less intensive respiratory support and, although there were more supplemental oxygen days, the duration of stay in the NICU was shorter. A larger study will have to replicate these findings.This study compared the outcomes of matched cohorts of preterm infants who were treated using 2 different automated oxygen controllers. Differences in morbidity were observed. The data suggest that it cannot be assumed that different automated controllers will produce similar results and that randomised controlled trials will be necessary to refine their use appropriately. Show less
Objective To compare the effect of two different automated oxygen control devices on target range (TR) time and occurrence of hypoxaemic and hyperoxaemic episodes.Design Randomised cross-over study... Show moreObjective To compare the effect of two different automated oxygen control devices on target range (TR) time and occurrence of hypoxaemic and hyperoxaemic episodes.Design Randomised cross-over study.Setting Tertiary level neonatal unit in the Netherlands.Patients Preterm infants (n=15) born between 24+0 and 29+6 days of gestation, receiving invasive or non-invasive respiratory support with oxygen saturation (SpO(2)) TR of 91%-95%. Median gestational age 26 weeks and 4 days (IQR 25 weeks 3days-27 weeks 6 days) and postnatal age 19 (IQR 17-24) days.Interventions Inspired oxygen concentration was titrated by the OxyGenie controller (SLE6000 ventilator) and the CLIO2 controller (AVEA ventilator) for 24 hours each, in a random sequence, with the respiratory support mode kept constant.Main outcome measures Time spent within set SpO(2) TR (91%-95% with supplemental oxygen and 91%-100% without supplemental oxygen).Results Time spent within the SpO(2) TR was higher during OxyGenie control (80.2 (72.6-82.4)% vs 68.5 (56.7-79.3)%, p<0.005). Less time was spent above TR while in supplemental oxygen (6.3 (5.1-9.9)% vs 15.9 (11.5-30.7)%, p<0.005) but more time spent below TR during OxyGenie control (14.7 (11.8%-17.2%) vs 9.3 (8.2-12.6)%, p<0.05). There was no significant difference in time with SpO(2) <80% (0.5 (0.1-1.0)% vs 0.2 (0.1-0.4)%, p=0.061). Long-lasting SpO(2) deviations occurred less frequently during OxyGenie control.Conclusions The OxyGenie control algorithm was more effective in keeping the oxygen saturation within TR and preventing hyperoxaemia and equally effective in preventing hypoxaemia (SpO(2) <80%), although at the cost of a small increase in mild hypoxaemia. Show less
Salverda, H.H.; Oldenburger, N.J.; Rijken, M.; Pauws, S.C.; Dargaville, P.A.; Pas, A.B. te 2021
Several studies demonstrated an increase in time spent within target range when automated oxygen control (AOC) is used. However the effect on clinical outcome remains unclear. We compared clinical... Show moreSeveral studies demonstrated an increase in time spent within target range when automated oxygen control (AOC) is used. However the effect on clinical outcome remains unclear. We compared clinical outcomes of preterm infants born before and after implementation of AOC as standard of care. In a retrospective pre-post implementation cohort study of outcomes for infants of 24-29 weeks gestational age receiving respiratory support before (2012-2015) and after (2015-2018) implementation of AOC as standard of care were compared. Outcomes of interest were mortality and complications of prematurity, number of ventilation days, and length of stay in the Neonatal Intensive Care Unit (NICU). A total of 588 infants were included (293 pre- vs 295 in the post-implementation cohort), with similar gestational age (27.8 weeks pre- vs 27.6 weeks post-implementation), birth weight (1033 grams vs 1035 grams) and other baseline characteristics. Mortality and rate of prematurity complications were not different between the groups. Length of stay in NICU was not different, but duration of invasive ventilation was shorter in infants who received AOC (6.4 +/- 10.1 vs 4.7 +/- 8.3, p = 0.029). Conclusion: In this pre-post comparison, the implementation of AOC did not lead to a change in mortality or morbidity during admission.What is Known:Prolonged and intermittent oxygen saturation deviations are associated with mortality and prematurity-related morbidities.Automated oxygen controllers can increase the time spent within oxygen saturation target range.What is New:Implementation of automated oxygen control as standard of care did not lead to a change in mortality or morbidity during admission.In the period after implementation of automated oxygen control, there was a shift toward more non-invasive ventilation. Show less
Mank, A.; Carrasco, C.C.; Thio, M.; Clotet, J.; Pauws, S.C.; DeKoninck, P.; Pas, A.B. te 2020
Objective To assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH).Design Prospective study.Setting Tertiary... Show moreObjective To assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH).Design Prospective study.Setting Tertiary neonatal intensive care unit.Patients Thirty infants with antenatally diagnosed CDH born at Hospital Sant Joan de Deu in Barcelona from September 2013 to September 2015.Interventions Spontaneous breaths and inflations given in the first 10 min after intubation at birth were recorded using respiratory function monitor. Only expired Vt of uninterrupted spontaneous breaths was included for analysis. Receiver operating characteristics (ROC) analysis was performed and the area under the curve (AUC) was estimated to assess the predictive accuracy of Vt.Main outcome measures Mortality before hospital discharge and chronic lung disease (CLD) at day 28 of life.Results There were 1.233 uninterrupted spontaneous breaths measured, and the overall mean Vt was 2.8 +/- 2.1 mL/kg. A lower Vt was found in infants who died (n=14) compared with survivors (n=16) (1.7 +/- 1.6 vs 3.7 +/- 2.1 mL/kg; p=0.008). Vt was lower in infants who died during admission or had CLD (n=20) compared with survivors without CLD (n=10) (2.0 +/- 1.7 vs 4.3 +/- 2.2 mL/kg; p=0.004). ROC analysis showed that Vt <= 2.2 mL/kg predicted mortality with 79% sensitivity and 81% specificity (AUC=0.77, p=0.013). Vt <= 3.4 mL/kg was a good predictor of death or CLD (AUC=0.80, p=0.008) with 85% sensitivity and 70% specificity.Conclusion Vt of spontaneous breaths measured immediately after birth is associated with mortality and CLD. Vt seems to be a reliable predictor but is not an independent predictor after adjustment for observed/expected lung to head ratio and liver position. Show less
