Quicker response results in better SpO2 control – a comparison of 3 FiO2-titration strategies in ventilated preterm infants
More details
Hide details
Medical Centre of Postgraduate Education, Warsaw, Poland
Czech Technical University of Prague
Silesia Institute of Mother and Newborn, Chorzów, Poland
I Department of Obstetrics and Gynecology, Medical Centre of Postgraduate Education, Warsaw, Poland
Corresponding author
Maria Wilińska   

Medical Centre of Postgraduate Education, Warsaw, Poland
Ann Agric Environ Med. 2015;22(4):708-712
The impact of SpO2 target ranges (TR) has been carefully studied; however, reports suggest a wide variation among infants and centres in maintaining the intended range. Little is known about the effectiveness of different approaches to manual control. Auto-SpO2 controllers are now available which show promise.

The aim was to compare two different protocol-driven manual strategies with different response requirements to each other, and a faster automated system (AveaCLiO2, Yorba Linda, CA, USA).

Material and Methods:
In a crossover design, each of the three FiO2/SpO2 approaches was implemented in three randomly assigned consecutive 2.5-hour runs. The two manual strategies (Attentive and Observational) were implemented by a trained operator. The primary endpoints were time in 1) SpO2 TR, 2) <80% SpO2 and 3) >98% SpO2.

Fifteen studies were completed. All three approaches resulted in good control, with time in the target range >60%. CLiO2 use reflected reduced exposure at the two SpO2 extremes. Post hoc analysis determined that the differences were more marked in the infants with more frequent desaturations. Likewise, in this group, the Attentive strategy performed better than the Observative.

All three approaches provided excellent control of SpO2 in infants with infrequent desaturations, significantly better than typical routine care. In hard to manage infants with frequent desaturations, faster response appeared to result in better control. The potential of automating the tedious error prone FiO2 adjustment offers significant promise. If manual titration of FiO2 is to remain the usual method of care, additional studies are needed to identify optimal approaches.

Tin W, Milligan WA, Pennefather P, Hey E. Pulse oximetry, severe retinopathy,and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed. 2001; 84: 106–10.
Deulofeut R, Critz A, Adams Chapman I, Sola A, et al. Avoiding hyperoxia in infants < 1250 g is associated with improved short term and long term outcomes. J Perinatology 2006;26:700–05.
Askie LM, Henderson-Smart DJ, Irwig L, Simpson JM. Oxygen saturation targets and outcomes in extremely preterm infants. N Engl J Med. 2003; 349: 959 –67.
The BOOSTII United Kingdom, Australia, New Zealand Collaborative Groups. Oxygen saturation and outcomes in preterm infants. N Engl J Med. 2013; 368(22): 2094–104.
SUPPORT Study Group of the Eunice Kennedy Shriver NICHD, Neonatal Research Network. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med. 2010; 362: 1959–69.
NeOProM: Neonatal Oxygenation Prospective Meta-analysis Collaboration study protocol. Askie LM, Brocklehurst P. BMC Pediatrics 2011; 11(6): 1–9.
Schmidt B, Whyte R, Aszalos, et al. Effects of targeting higher vs lower oxygenation saturations on death or disability in extremely preterm infants. JAMA 2013; 309(20): 2111–20.
Laptook AR, Salhab W, Allen J, et al. Pulse oximetry in very low birth weight infants: Can oxygen saturation be maintained in the desired range? J Perinatol. 2006; 26: 337–41.
Hagadorn JI, Furey AM, Nghiem TH, et al. Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks‘gestation: the AVIOx study. Pediatrics 2006; 118: 1574–82.
Bitan Y, Meyer J, Shinar D, Zmora E. Nurses’ reactions to alarms in a neonatal intensive care unit. Cogn Tech Work. 2004; 6: 239–46.
Armbruster J, Schmidt B, Poets CF, Bassler D. Nurses’ compliance with alarm limits for pulse oximetry: qualitative study. J Perinat. 2009; 189: 1–4.
Clucas L, Doyle LW, Dawson J, et al. Compliance with alarm limits for pulse oximetry in very preterm infants. Pediatrics 2007; 119: 1056–60.
Nghiem TH, Hagadorn JI, Terrin N, et al. Nurse opinions and pulse oximeter saturation target limits for preterm infants. Pediatrics 2008; 121: 1039–46.
Chow LC, Wright KW, Sola A, et al. Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics 2003; 111: 339–45.
Ford SP, Leick-Rude MK, Meinart KA, et al. Overcoming barriers to oxygenation saturation targeting. Pediatrics 2006; 118: s177–86.
Urschitz MS, Horn W, Seyfang A, et al. Automatic control of the inspired oxygen fraction in preterm infants: a randomized crossover trial. Am J Respir Crit Care Med. 2004; 170: 1095–100.
Null D, Gerstman DL. Clinical evaluation of a closed loop oxygen controller for neonatal respiratory care. Clinical February 2010.
Claure N, Gerhardt T, Everett R, et al. Closed loop controlled inspired oxygen concentration for mechanically ventilated very low birth weight infants with frequent episodes of hypoxemia. Pediatrics 2001; 107: 1120–4.
Claure N, D’Ugard C, Bancalari E. Automated adjustment of inspired oxygen in preterm infants with frequent fluctuations in oxygenation: a pilot clinical trial. J Pediatr. 2009; 155: 640–5.
Claure N, Bancalari E, D’Ugard C, et al. Automated adjustment of inspired oxygen in mechanically ventilated preterm infants: a multicenter crossover trial. Pediatrics 2011; 127: e76–3.
Wilinska M, Bachman T, Swietlinski. Time required for effective FiO2 titration in preterm infants: a comparison. Neonatal IC 2012; 25(5): 44–6.
Carlo WA, Finer NN, Gantz MG. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med. 2010; 363(13): 1285–1286.
Journals System - logo
Scroll to top