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More time in optimal SpO2 range with closed-loop FiO2 control

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Date of first publication: 08.11.2022

A recent study in pediatric patients showed they spent significantly more time in the optimal SpO2 range with closed-loop control of FiO2 than with manual FiO2 titration (1). The number of adjustments was also significantly higher and the oxygen usage lower with closed-loop FiO2 control.
More time in optimal SpO2 range with closed-loop FiO2 control

This randomized crossover trial included 30 patients with an average age of 21 months and heterogenous lung conditions. The investigators at the Dr Behcet Uz Children's Disease and Surgery Training and Research Hospital in Izmir, Turkey, ventilated them with standard Adaptive Support Ventilation® settings for two phases. During one, the INTELLiVENT-ASV FiO2 controller was activated and during the other, FiO2 was titrated manually. Minute ventilation and PEEP were maintained at the same level during the two phases.

Key findings

Compared with manual FiO2 titration, activation of the FiO2 controller resulted in:

  • Significantly more time spent in the optimal SpO2 range (96.1% vs 78.4%; p < 0.001)
  • Significantly less time spent in unacceptably low, suboptimally low, acceptably low, and suboptimally high SpO2 ranges
  • A far greater total number of adjustments (total number per patient 52 vs 1)
  • A lower median oxygenation index and lower median O2 usage 

These findings indicate the potential for greater efficiency with closed-loop FiO2 control - not only in terms of oxygen requirements, but also in terms of the number of adjustments possible without increasing the staff's workload.

See full citation below: (Soydan E, Ceylan G, Topal S, et al. Automated closed-loop FiO2 titration increases the percentage of time spent in optimal zones of oxygen saturation in pediatric patients-A randomized crossover clinical trial. Front Med (Lausanne). 2022;9:969218. Published 2022 Aug 25. doi:10.3389/fmed.2022.9692181​)

Footnotes

References

  1. 1. Soydan E, Ceylan G, Topal S, et al. Automated closed-loop FiO2 titration increases the percentage of time spent in optimal zones of oxygen saturation in pediatric patients-A randomized crossover clinical trial. Front Med (Lausanne). 2022;9:969218. Published 2022 Aug 25. doi:10.3389/fmed.2022.969218

Automated closed-loop FiO2 titration increases the percentage of time spent in optimal zones of oxygen saturation in pediatric patients-A randomized crossover clinical trial.

Soydan E, Ceylan G, Topal S, et al. Automated closed-loop FiO2 titration increases the percentage of time spent in optimal zones of oxygen saturation in pediatric patients-A randomized crossover clinical trial. Front Med (Lausanne). 2022;9:969218. Published 2022 Aug 25. doi:10.3389/fmed.2022.969218



Introduction

We aimed to compare automated ventilation with closed-loop control of the fraction of inspired oxygen (FiO2) to automated ventilation with manual titrations of the FiO2 with respect to time spent in predefined pulse oximetry (SpO2) zones in pediatric critically ill patients.

Methods

This was a randomized crossover clinical trial comparing Adaptive Support Ventilation (ASV) 1.1 with use of a closed-loop FiO2 system vs. ASV 1.1 with manual FiO2 titrations. The primary endpoint was the percentage of time spent in optimal SpO2 zones. Secondary endpoints included the percentage of time spent in acceptable, suboptimal and unacceptable SpO2 zones, and the total number of FiO2 changes per patient.

Results

We included 30 children with a median age of 21 (11-48) months; 12 (40%) children had pediatric ARDS. The percentage of time spent in optimal SpO2 zones increased with use of the closed-loop FiO2 controller vs. manual oxygen control [96.1 (93.7-98.6) vs. 78.4 (51.3-94.8); P < 0.001]. The percentage of time spent in acceptable, suboptimal and unacceptable zones decreased. Findings were similar with the use of closed-loop FiO2 controller compared to manual titration in patients with ARDS [95.9 (81.6-98.8) vs. 78 (49.5-94.8) %; P = 0.027]. The total number of closed-loop FiO2 changes per patient was 52 (11.8-67), vs. the number of manual changes 1 (0-2), (P < 0.001).

Conclusion

In this randomized crossover trial in pediatric critically ill patients under invasive ventilation with ASV, use of a closed-loop control of FiO2 titration increased the percentage of time spent within in optimal SpO2 zones, and increased the total number of FiO2 changes per patient.

Clinical trial registration

ClinicalTrials.gov, identifier: NCT04568642.