Anotace:
Continuous monitoring with pulse oximetry is the standard of care for titrating inspired oxygen in the neonatal ICU. However titrating supplemental oxygen to address frequent desaturations is a challenging task for caregivers. Increasing exposure to SpO2 extremes is associated with increasingly poorer long-term outcomes. More recently the prevalence of prolonged episodes at extremes and cluster of short episodes have been reported to be also associated with bad outcomes. We speculated that more complex episodes might also have an impact on outcomes. We defined two sets of these: clusters and swings. Automatic control of inspired oxygen based on continuous pulse oximetry, is available on many neonatal ventilators. Some have expressed concern that continuous adjustment of inspired oxygen, without observing the infant, might cause instability and thus increased prevalence of clusters and oscillations. The aim of this study was to determine the prevalence of these complex events and determine if they were more common during automated control. To accomplish this we analyzed data of 58 extremely preterm newborns that were ventilated at least 24 hours with manual inspiratory oxygen control and at least 24 hours with automated FiO2 control, in random order. We found that clusters and swings were quite prevalent, that is similar to the prevalence of prolonged episodes that have been shown to be associated with bad outcomes. We also found that these complex events were reduced during automated control, rather than increased. Finally, we suggest that additional research in this area is warranted.