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Sturrock S, Williams E, Dassios T, Greenough A. Closed loop automated oxygen control in neonates-A review. Acta Paediatr 2020; 109:914-922. [PMID: 31715041 DOI: 10.1111/apa.15089] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
AIM Neonates frequently require supplementary oxygen but may develop complications if the oxygen saturation is outside the target range. This review aimed to determine whether the algorithms used in closed loop automated oxygen control systems influenced their efficacy and whether use of the systems reduced relevant, long-term neonatal complications. METHODS A literature search was conducted using PubMed and Google Scholar. The search terms were 'closed loop' or 'automat*', 'oxygen' and 'neonat*'. RESULTS Eighteen studies were identified: sixteen comparison clinical studies, an observational study and an animal study. Overall, closed loop automated oxygen control was associated with an increased percentage of time spent within the target oxygen saturation range and there were fewer manual adjustments to the inspired oxygen concentration when compared with manual oxygen control. The systems were effective in infants on non-invasive respiratory support or mechanically ventilated, but no study included term-born infants. No long-term data were available to determine if complications of oxygen toxicity were reduced. CONCLUSION Closed loop automated oxygen control has been shown in short term trials including preterm and low birth weight infants to improve target saturation achievement. Whether long-term outcomes will be improved with their use requires investigation.
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Affiliation(s)
- Sarah Sturrock
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
| | - Emma Williams
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
| | - Theodore Dassios
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Neonatal Intensive Care Centre King’s College Hospital London UK
| | - Anne Greenough
- Women and Children’s Health School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- The Asthma UK Centre in Allergic Mechanisms of Asthma King's College London London UK
- National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust King’s College London London UK
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Faqeeh A, Hou X, Zaniletti I, Pardalos J, Amjad R, Fales R. Comparison of Automated and Manual Peripheral Oxygen Saturation Control Applied to One Human Subject at a High Target Range. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3346-3349. [PMID: 30441105 DOI: 10.1109/embc.2018.8513048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Newborn infants, mainly those born prematurely, often require respiratory support with a varying concentration of the fraction of inspired oxygen (FiO$_{\mathbf {2}}$) to keep the peripheral oxygen saturation (SpO$_{\mathbf {2}}$) within the desired range to prevent adverse health effects due to both high and low SpO$_{\mathbf {2}}$. Manual adjustment, by nurses, is the common practice. However, the efficacy of the manual control is questionable. A novel automatic controller is evaluated clinically with application to one human subject at a high target SpO$_{\mathbf {2}}$. The automatic controller demonstrated the ability to improve oxygen saturation control over the everyday routine manual control by increasing the proportion of time where SpO$_{\mathbf {2}}\textbf{v}$alues were within the desired range.
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Faqeeh A, Fales R, Pardalos J, Amjad R, Zaniletti I, Hou X. Engineering Evaluation of the Performance of an Automatic Peripheral Oxygen Controller Using a Neonatal Respiratory Model. J Med Device 2018. [DOI: 10.1115/1.4040188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Premature infants often require respiratory support with a varying concentration of the fraction of inspired oxygen FiO2 to keep the arterial oxygen saturation typically measured using a peripheral sensor (SpO2) within the desired range to avoid both hypoxia and hyperoxia. The widespread practice for controlling the fraction of inspired oxygen is by manual adjustment. Automatic control of the oxygen to assist care providers is desired. A novel closed-loop respiratory support device with dynamic adaptability is evaluated nonclinically by using a neonatal respiratory response model. The device demonstrated the ability to improve oxygen saturation control over manual control by increasing the proportion of time where SpO2 is within the desired range while minimizing the episodes and periods where SpO2 of the neonatal respiratory model is out of the target range.
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Affiliation(s)
- Akram Faqeeh
- Mechanical and Aerospace Engineering, University of Missouri, E2412 Lafferre Hall, Columbia, MO 65211 e-mail:
| | - Roger Fales
- Mechanical and Aerospace Engineering, University of Missouri, E2412 Lafferre Hall, Columbia, MO 65211 e-mail:
| | - John Pardalos
- Neonatology, University of Missouri Health, 400 N. Keene Street, Columbia, MO 65212 e-mail:
| | - Ramak Amjad
- Neonatology, University of Missouri Health, 400 N. Keene Street, Columbia, MO 65212 e-mail:
| | - Isabella Zaniletti
- Statistics, University of Missouri, 146 Middlebush Hall, Columbia, MO 65211 e-mail:
| | - Xuefeng Hou
- Mechanical and Aerospace Engineering, University of Missouri, E2412 Lafferre Hall, Columbia, MO 65211 e-mail:
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Automated control of inspired oxygen for preterm infants: What we have and what we need. Biomed Signal Process Control 2016. [DOI: 10.1016/j.bspc.2016.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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van Zanten HA, Tan RNGB, van den Hoogen A, Lopriore E, te Pas AB. Compliance in oxygen saturation targeting in preterm infants: a systematic review. Eur J Pediatr 2015; 174:1561-72. [PMID: 26468116 PMCID: PMC4662723 DOI: 10.1007/s00431-015-2643-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015. Sixteen studies were selected, which involved a total of 2935 nurses and 574 infants. The studies varied in methodology, and we have therefore used a narrative account to describe the data. The main finding is that there is a low compliance in oxygen targeting; the upper alarm limits are inappropriately set, and maintaining the saturation (SpO2) below the upper limit presented particular difficulties. Although there is little data available, the studies indicate that training, titration protocols and decreasing workload could improve awareness and compliance. Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range. CONCLUSION The compliance in targeting oxygen during oxygen therapy in preterm infants is low, especially in maintaining the SpO2 below the upper limit. WHAT IS KNOWN • The use of oxygen in preterm infants is vital, but the optimal strategyremains controversial. • Targeting SpO2 during oxygen therapy in preterm infants has beenshown to reduce mortality and morbidity. WHAT IS NEW • Review of the literature showed that the compliance in targeting SpO2and alarm settings is low. • Creating awareness of risks of oxygen therapy and benefits in targeting,decreasing nurse/patient ratio and automated oxygen therapy couldincrease compliance.
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Affiliation(s)
- Henriëtte A van Zanten
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Ratna N G B Tan
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | | | - Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Arjan B te Pas
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Pires DEPD, Bertoncini JH, Trindade LDL, Matos E, Azambuja E, Borges AMF. Inovação tecnológica e cargas de trabalho dos profissionais de saúde: uma relação ambígua. Rev Gaucha Enferm 2012; 33:157-68. [DOI: 10.1590/s1983-14472012000100021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Trata-se de uma revisão integrativa com objetivo de rastrear a produção científica acerca da influência da inovação tecnológica nas cargas de trabalho dos profissionais de saúde. Selecionou-se 57 publicações nas bases de interesse de 2004 a 2009. Predominaram as pesquisas de campo com abordagem qualitativa, realizadas em hospitais. Nenhum estudo teve por objetivo relacionar inovação tecnológica e cargas de trabalho. Nos estudos sobre inovação tecnológica destacaram-se publicações sobre tecnologias de informação e comunicação e novas formas de organização do trabalho; no tema cargas de trabalho predominaram estudos sobre condições promotoras de estresse e Burnout. Os achados mostraram que as inovações influenciam as cargas de trabalho de modo ambíguo, podendo aumentá-las ou diminuí-las.
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Affiliation(s)
| | | | | | | | - Eliana Azambuja
- Instituto Federal do Rio Grande do Sul; Universidade Federal do Rio Grande, Brasil
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Abstract
The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals caring for children. The calculation of the percentage of arterial oxyhemoglobin is based on the distinct characteristics of light absorption in the red and infrared spectra by oxygenated versus deoxygenated hemoglobin and takes advantage of the variation in light absorption caused by the pulsatility of arterial blood. Computation of oxygen saturation is achieved with the use of calibration algorithms. Safe use of pulse oximetry requires knowledge of its limitations, which include motion artifacts, poor perfusion at the site of measurement, irregular rhythms, ambient light or electromagnetic interference, skin pigmentation, nail polish, calibration assumptions, probe positioning, time lag in detecting hypoxic events, venous pulsation, intravenous dyes, and presence of abnormal hemoglobin molecules. In this review we describe the physiologic principles and limitations of pulse oximetry, discuss normal values, and highlight its importance in common pediatric diseases, in which the principle mechanism of hypoxemia is ventilation/perfusion mismatch (eg, asthma exacerbation, acute bronchiolitis, pneumonia) versus hypoventilation (eg, laryngotracheitis, vocal cord dysfunction, foreign-body aspiration in the larynx or trachea). Additional technologic advancements in pulse oximetry and its incorporation into evidence-based clinical algorithms will improve the efficiency of the method in daily pediatric practice.
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Affiliation(s)
- Sotirios Fouzas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras, Rio, 265 04 Patras, Greece.
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Broadbent R. Re: AP-ROP in an infant with minimal oxygen exposure. J Paediatr Child Health 2010; 46:210-1. [PMID: 20546484 DOI: 10.1111/j.1440-1754.2010.01760.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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D'Agostino DP, Olson JE, Dean JB. Acute hyperoxia increases lipid peroxidation and induces plasma membrane blebbing in human U87 glioblastoma cells. Neuroscience 2009; 159:1011-22. [PMID: 19356685 DOI: 10.1016/j.neuroscience.2009.01.062] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 01/26/2009] [Accepted: 01/27/2009] [Indexed: 11/28/2022]
Abstract
Atomic force microscopy (AFM), malondialdehyde (MDA) assays, and amperometric measurements of extracellular hydrogen peroxide (H(2)O(2)) were used to test the hypothesis that graded hyperoxia induces measurable nanoscopic changes in membrane ultrastructure and membrane lipid peroxidation (MLP) in cultured U87 human glioma cells. U87 cells were exposed to 0.20 atmospheres absolute (ATA) O(2), normobaric hyperoxia (0.95 ATA O(2)) or hyperbaric hyperoxia (HBO(2), 3.25 ATA O(2)) for 60 min. H(2)O(2) (0.2 or 2 mM; 60 min) was used as a positive control for MLP. Cells were fixed with 2% glutaraldehyde immediately after treatment and scanned with AFM in air or fluid. Surface topography revealed ultrastructural changes such as membrane blebbing in cells treated with hyperoxia and H(2)O(2). Average membrane roughness (R(a)) of individual cells from each group (n=35 to 45 cells/group) was quantified to assess ultrastructural changes from oxidative stress. The R(a) of the plasma membrane was 34+/-3, 57+/-3 and 63+/-5 nm in 0.20 ATA O(2), 0.95 ATA O(2) and HBO(2), respectively. R(a) was 56+/-7 and 138+/-14 nm in 0.2 and 2 mM H(2)O(2). Similarly, levels of MDA were significantly elevated in cultures treated with hyperoxia and H(2)O(2) and correlated with O(2)-induced membrane blebbing (r(2)=0.93). Coapplication of antioxidant, Trolox-C (150 microM), significantly reduced membrane R(a) and MDA levels during hyperoxia. Hyperoxia-induced H(2)O(2) production increased 189%+/-5% (0.95 ATA O(2)) and 236%+/-5% (4 ATA O(2)) above control (0.20 ATA O(2)). We conclude that MLP and membrane blebbing increase with increasing O(2) concentration. We hypothesize that membrane blebbing is an ultrastructural correlate of MLP resulting from hyperoxia. Furthermore, AFM is a powerful technique for resolving nanoscopic changes in the plasma membrane that result from oxidative damage.
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Affiliation(s)
- D P D'Agostino
- Department of Molecular Pharmacology and Physiology, Hyperbaric Biomedical Research Laboratory, College of Medicine, MDC 8, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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