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Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis

Journal of Perinatology volume 38, pages 351–360 (2018)Cite this article

Subjects

Abstract

Objectives

To conduct a systematic review of clinical trials comparing automated versus manual fraction of inspired oxygen (FiO2) control to target oxygen saturation (SpO2) in preterm infants.

Design

The authors searched MEDLINE, Embase, CENTRAL, and CINAHL from inception upto December 2016, reviewed conference proceedings and sought results of unpublished trials. Studies were included if automated FiO2 control was compared to manual control in preterm infants on positive pressure respiratory support. The primary outcome was percentage of time spent within the target SpO2 range. Summary mean differences (MD) were computed using random effects model.

Results

Out of 276 identified studies 10 met the inclusion criteria. Automated FiO2 control significantly improved time being spent within the target SpO2 range [MD: 12.8%; 95% CI: 6.5–19.2%; I2 = 90%]. Periods of hyperoxia (MD:–8.8%; 95% CI: –15 to –2.7%), severe hypoxia(SpO2  < 80%)(MD: –0.9%;95%CI: –1.5 to –0.4%) and hypoxic events (MD: –5.6%; 95% CI: –9.1 to –2.1%) were significantly reduced with automated control.

Conclusion

Automated FiO2 adjustment provides significant improvement of time in target saturations, reduces periods of hyperoxia, and severe hypoxia in preterm infants on positive pressure respiratory support.

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Acknowledgements

The authors would like to thank Dr P Dargaville, Associate Professor of Pediatrics and Child Health, University of Tasmania, Australia for providing additional information on unpublished research work which was subsequently published during the course of the systematic review. The authors would also like to thank Darlene Chapman, librarian, IWK Health Sciences Library, Halifax, NS, Canada for providing expert help in building the electronic search strategy.

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Authors and Affiliations

  1. Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University & IWK Health Centre, Halifax, NS, Canada

    Souvik Mitra, Balpreet Singh, Walid El-Naggar & Douglas D. McMillan

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  1. Souvik Mitra
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  2. Balpreet Singh
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Correspondence to Souvik Mitra.

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Mitra, S., Singh, B., El-Naggar, W. et al. Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis. J Perinatol 38, 351–360 (2018). https://doi.org/10.1038/s41372-017-0037-z

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