Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis

Abstract

Objectives: To conduct a systematic review of clinical trials comparing automated versus manual fraction of inspired oxygen (FiO₂) control to target oxygen saturation (SpO₂) in preterm infants.

Design: The authors searched MEDLINE, Embase, CENTRAL, and CINAHL from inception upto December 2016, reviewed conference proceedings and sought results of unpublished trials. Studies were included if automated FiO₂ control was compared to manual control in preterm infants on positive pressure respiratory support. The primary outcome was percentage of time spent within the target SpO₂ range. Summary mean differences (MD) were computed using random effects model.

Results: Out of 276 identified studies 10 met the inclusion criteria. Automated FiO₂ control significantly improved time being spent within the target SpO₂ range [MD: 12.8%; 95% CI: 6.5-19.2%; I² = 90%]. Periods of hyperoxia (MD:-8.8%; 95% CI: -15 to -2.7%), severe hypoxia(SpO₂ < 80%)(MD: -0.9%;95%CI: -1.5 to -0.4%) and hypoxic events (MD: -5.6%; 95% CI: -9.1 to -2.1%) were significantly reduced with automated control.

Conclusion: Automated FiO₂ adjustment provides significant improvement of time in target saturations, reduces periods of hyperoxia, and severe hypoxia in preterm infants on positive pressure respiratory support.