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在闭环 FiO2 控制下增加处于最佳氧饱和度范围的时间

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日期: 08.11.2022

最近一项对儿童病人的研究显示，病人在闭环 FiO2 控制下处于最佳氧饱和度范围的时间显著多于手动 FiO2 滴定 (1)。另外在闭环 FiO2 控制下，调节次数明显更多，氧气使用率更低。
在闭环 FiO2 控制下增加处于最佳氧饱和度范围的时间

本次随机交叉试验纳入了 30 名病人，平均年龄 21 个月且有异质性肺疾病。土耳其伊兹密尔 (Izmir) 的儿童疾病与外科培训研究 (Dr Behcet Uz Children's Disease and Surgery Training and Research Hospital) 医院的研究者采用标准适应性支持通气®设置对他们进行了两个阶段的通气治疗。在一个阶段激活 INTELLiVENT‑ASV FiO2 控制器，在另一个阶段手动滴定 FiO2。在两个阶段使分钟通气量和 PEEP 维持在同一水平。

关键成果

相比手动 FiO2 滴定，激活 FiO2 控制器导致：

  • 处于最佳氧饱和度范围的时间显著增加（96.1% 与 78.4%；p <；0.001）
  • 处于不可接受低、次优低、可接受低和次优高氧饱和度范围的时间显著减少
  • 调节总次数显著增多（每名病人总数 52 与 1 次）
  • 中位数氧合状态指数降低及中位数氧气使用率降低 

这些研究发现表明闭环 FiO2 控制效率提高的潜力‑‑不仅在氧气需求方面，还包括在不增加工作人员工作量的情况下可能调节的次数方面。

参考下面完整引用： (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​)

脚注

参考文献

  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.