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Wilinska M, Bachman TE, Piwowarczyk P, Kostuch M, Tousty J, Berła K, Hajdar R, Skrzypek M. Routine use of automated FiO 2 control in Poland: prospective registry and survey. Front Pediatr 2023; 11:1213310. [PMID: 37719452 PMCID: PMC10502171 DOI: 10.3389/fped.2023.1213310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Objective The performance of automated control of inspired oxygen (A-FiO2) has been confirmed in dozens of studies but reports of routine use are limited. Broadly adopted in Poland, our aim is to share that experience. Methods We used a prospectively planned observational study of the performance, general use patterns, unit practices, and problems with A-FiO2, based on a web registry of case reports, complemented by surveys of subjective impressions. Results In 2019, a total of 92 A-FiO2 systems were in routine use in 38 centers. Of the 38 centers, 20 had agreed in 2013 to participate in the project. In these centers, A-FiO2 was applied in infants of all weights, but some centers restricted its use to weaning from oxygen and unstable infants. A cohort had reported their experience with each use (5/20 centers, 593 cases). A quarter of those infants were managed with a lower target range and three-quarters with alarms looser than European guidelines for manual SpO2 control. The perceived primary advantages of A-FiO2 were as follows: keeping the readings in the target range, reducing exposure to SpO2 extremes, reducing risk from nurse distraction, reducing workload, and reducing alarm fatigue. Practices did evolve with experience, including implementing changes in the alarm strategy, indications for use, and target range. The potential for over-reliance on automation was cited as a risk. There were a few reports of limited effectiveness (moderate 12/593 and poor 2/593). Conclusions Automated oxygen control is broadly perceived by users as an improvement in controlling SpO2 with infrequent problems.
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Affiliation(s)
- M. Wilinska
- Department of Neonatology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - T. E. Bachman
- Department Medical Technology, School of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - P. Piwowarczyk
- Clinical Department of Neonatology, Independent Public Hospital, Warsaw, Poland
| | - M. Kostuch
- Department of Neonatology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - J. Tousty
- Department of Neonatology and Intensive Neonatal Care, Pomeranian Medical University, Szczecin, Poland
| | - K. Berła
- Department of Neonatology, Complex of Health Care Facilities, Ostrow Wielkopolski, Poland
| | - R. Hajdar
- Department of Neonatology, Provincial Specialist Hospital, Biala Podlaska, Poland
| | - M. Skrzypek
- Department of Biostatistics Medical University of Silesia, School of Health Sciences in Bytom, Bytom, Poland
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Chavez TA, Lakshmanan A, Figueroa L, Iyer N, Stavroudis TA, Garingo A, Friedlich PS, Ramanathan R. Resource utilization patterns using non-invasive ventilation in neonates with respiratory distress syndrome. J Perinatol 2018; 38:850-856. [PMID: 29795324 PMCID: PMC8362839 DOI: 10.1038/s41372-018-0122-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 02/21/2018] [Accepted: 03/30/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To describe the frequency of non-invasive ventilation (NIV) and endotracheal intubation use in neonates diagnosed with respiratory distress syndrome (RDS); to describe resources utilization (length of stay (LOS), charges, costs) among NIV and intubated RDS groups. STUDY DESIGN Retrospective study from the national Kid's Inpatient Database of the Healthcare Cost and Utilization Project, for the years 1997-2012. Propensity scoring and multivariate regression analysis used to describe differences. RESULTS A total of 595,254 out of 42,912,090 cases were identified with RDS. There was an increase in NIV use from 6% in 1997 to 17% in 2012. After matching, patients receiving NIV only were associated with shorter LOS: (95%CI) 25 (25.3,25.7) vs. 35 (34.2,34.9) days, decreased costs: ($/1k) 46.1 (45.5,46.8) vs. 65.0 (64.1,66.0), decreased charges: 130.3 (128.6,132.1) vs. 192.1 (189.5,194.6) compared to intubated neonates. CONCLUSION There was a three-fold increase in NIV use within the 15-year study period. NIV use was associated with decreased LOS, charges and costs compared to intubated patients.
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Affiliation(s)
- Thomas A. Chavez
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States.
| | - Lizzette Figueroa
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Narayan Iyer
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theodora A. Stavroudis
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Arlene Garingo
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe S. Friedlich
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Division of Neonatology, Department of Pediatrics, LAC USC Medical Center, University of Southern California, Los Angeles, CA, USA
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