Remote Closed-Loop Automatic Oxygen Control in Preterm Infants

2019 ◽  
Author(s):  
Mohammad Reza Moradi ◽  
Sharareh R. Niakan Kalhori ◽  
Marian Ghazi Saeedi ◽  
Mohammad Reza Zarkesh ◽  
Abbas Habibelahi ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Pulse Oximeter ◽  
Closed Loop ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Target Range ◽  
Preterm Neonates ◽  
Oxygen Control ◽  
The Mean ◽  
Fraction Of Inspired Oxygen

Abstract Background Different automated systems have been developed to improve maintenance of target range of arterial oxygen saturation (SPO2) in premature infants with respiratory distress. This study aimed to develop a Remote Closed-Loop Automatic Oxygen Control (RCLAC) as an efficient monitoring device. Then the mean of fraction of inspired oxygen (FIO2) and SPO2 by routine manual control (RMC) and RCLAC were compared.Methods A developmental-descriptive study was carried out in an Iranian hospital (Tehran-Iran; 2015-2017). Eighteen preterm infants with gestational age 24-28 weeks entered the study. A database was prepared based on pulse oximeter parameters. A Wi-Fi module was implemented to receive data from pulse oximeter and send inputs to user's mobile. Vibrate alarm was implemented for high or low FIO2. After receiving notifications associated with increase or decrease of FIO2 levels and user's confirmation; the alterations were applied on the ventilator.Results The mean FIO2 in RMC system was significantly higher than RCLAC system (98.1± 2.67 vs. 79.5±16.03; p = 0.0001). According to the results, when the SPO2 reached close to target SPO2 range and consequently FIO2 changed (decreased or increased based on target SPO2), heart rate showed a regular beating with decrease in the numbers.Conclusion Remote Closed-Loop Automatic Oxygen Control system as a simple device could prevent preterm neonates from sustained hypo-hyperoxemic and arrhythmia episodes. Moreover by using RCLAC, there was no need for continuous monitoring that may reduce workload of NICUs medical staff. Collecting reliable data and recording information in digital forms were also other benefits.

scholarly journals Designing a Remote Closed-Loop Automatic Oxygen Control in Preterm Infants

2020 ◽  
Vol 30 (4) ◽  
Author(s):  
Mohammad Reza Moradi ◽  
Sharareh R. Niakan Kalhori ◽  
Marian Ghazi Saeedi ◽  
Mohammad Reza Zarkesh ◽  
Abbas Habibelahi ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Pulse Oximeter ◽  
Closed Loop ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Target Range ◽  
Preterm Neonates ◽  
Oxygen Control ◽  
Fraction Of Inspired Oxygen ◽  
To Receive

Background: Different automated systems have been developed to improve the maintenance of target range of arterial oxygen saturation (SPO2) in premature infants with respiratory distress. Objectives: This study aimed to develop a remote closed-loop automatic oxygen control (RCLAC) as an efficient monitoring device. Then the means of the fraction of inspired oxygen (FIO2) and SPO2 by routine manual control (RMC) and RCLAC were compared. Methods: A developmental-descriptive study was carried out in an Iranian hospital (Tehran, Iran; 2015 - 2017). Twenty-two preterm infants with gestational age 24 - 28 weeks entered the study. A database was prepared based on pulse oximeter parameters. A Wi-Fi module was implemented to receive data from a pulse oximeter and send inputs to the user’s mobile. Vibrate alarm was implemented for high or low FIO2. After receiving notifications associated with an increase or decrease of FIO2 levels and user’s confirmation; the alterations were applied on the ventilator. Results: The mean FIO2 in the RMC system was significantly higher than the RCLAC system (98.1 ± 2.67 vs 79.5 ± 16.03; P = 0.0001). According to the results, when the SPO2 reached close to target SPO2 range and consequently FIO2 changed (decreased or increased based on target SPO2), heart rate showed a regular beating with a decrease in the numbers. Conclusions: Remote closed-loop automatic oxygen control system as a simple device could prevent preterm neonates from sustained hypo-hyperoxemic and arrhythmia episodes. Moreover, by using RCLAC, there was no need for continuous monitoring that may reduce the workload of NICU medical staff. Collecting reliable data and recording information in digital forms were also other benefits. Further studies with larger sample size are strongly suggested.

Randomised crossover trial comparing algorithms and averaging times for automatic oxygen control in preterm infants

2021 ◽  
pp. fetalneonatal-2021-322096
Author(s):  
Christoph E Schwarz ◽  
Karen B Kreutzer ◽  
Lukas Langanky ◽  
Nicole S Wolf ◽  
Wolfgang Braun ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Random Order ◽  
Target Range ◽  
Oxygen Control ◽  
Non Invasive ◽  
Fraction Of Inspired Oxygen ◽  
Averaging Time ◽  
Randomised Controlled ◽  
Gestational Age At Birth

ObjectiveAutomatic control (SPOC) of the fraction of inspired oxygen (FiO2), based on continuous analysis of pulse oximeter saturation (SpO2), improves the proportion of time preterm infants spend within a specified SpO2-target range (Target%). We evaluated if a revised SPOC algorithm (SPOCnew, including an upper limit for FiO2) compared to both routine manual control (RMC) and the previously tested algorithm (SPOCold, unrestricted maximum FiO2) increases Target%, and evaluated the effect of the pulse oximeter’s averaging time on controlling the SpO2 signal during SPOC periods.DesignUnblinded, randomised controlled crossover study comparing 2 SPOC algorithms and 2 SpO2 averaging times in random order: 12 hours SPOCnew and 12 hours SPOCold (averaging time 2 s or 8 s for 6 hours each) were compared with 6-hour RMC. A generated list of random numbers was used for allocation sequence.SettingUniversity-affiliated tertiary neonatal intensive care unit, GermanyPatientsTwenty-four infants on non-invasive respiratory support with FiO2 >0.21 were analysed (median gestational age at birth, birth weight and age at randomisation were 25.3 weeks, 585 g and 30 days).Main outcome measureTarget%.ResultsMean (SD) [95% CI] Target% was 56% (9) [52, 59] for RMC versus 69% (9) [65, 72] for SPOCold_2s, 70% (7) [67, 73] for SPOCnew_2s, 71% (8) [68, 74] for SPOCold_8s and 72% (8) [69, 75] for SPOCnew_8s.ConclusionsIrrespective of SpO2-averaging time, Target% was higher with both SPOC algorithms compared to RMC. Despite limiting the maximum FiO2, SPOCnew remained significantly better at maintaining SpO2 within target range compared to RMC.Trial registrationNCT03785899

scholarly journals Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 205
Author(s):  
Marlies Bruckner ◽  
Lukas P. Mileder ◽  
Alisa Richter ◽  
Nariae Baik-Schneditz ◽  
Bernhard Schwaberger ◽  
...  
Keyword(s):  
Body Temperature ◽  
Caesarean Section ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Near Infrared ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Secondary Outcome ◽  
Tissue Oxygen Saturation ◽  
Preterm Neonates

Body temperature (BT) management remains a challenge in neonatal intensive care, especially during resuscitation after birth. Our aim is to analyze whether there is an association between the BT and cerebral and peripheral tissue oxygen saturation (crSO2/cTOI and prSO2), arterial oxygen saturation (SpO2), and heart rate (HR). The secondary outcome parameters of five prospective observational studies are analyzed. We include preterm and term neonates born by Caesarean section who received continuous pulse oximetry and near-infrared spectroscopy monitoring during the first 15 min, and a rectal BT measurement once in minute 15 after birth. Four-hundred seventeen term and 169 preterm neonates are included. The BT did not correlate with crSO2/cTOI and SpO2. The BT correlated with the HR in all neonates (ρ = 0.210, p < 0.001) and with prSO2 only in preterm neonates (ρ = −0.285, p = 0.020). The BT was lower in preterm compared to term infants (36.7 [36.4–37.0] vs. 36.8 [36.6–37.0], p = 0.001) and prevalence of hypothermia was higher in preterm neonates (29.5% vs. 12.0%, p < 0.001). To conclude, the BT did not correlate with SpO2 and crSO2/cTOI, however, there was a weak positive correlation between the BT and the HR in the whole cohort and a weak correlation between the BT and prSO2 only in preterm infants. Preterm neonates had a statistically lower BT and suffered significantly more often from hypothermia during postnatal transition.

Engineering Evaluation of the Performance of an Automatic Peripheral Oxygen Controller Using a Neonatal Respiratory Model

2018 ◽  
Vol 12 (3) ◽  
Author(s):  
Akram Faqeeh ◽  
Roger Fales ◽  
John Pardalos ◽  
Ramak Amjad ◽  
Isabella Zaniletti ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Arterial Oxygen Saturation ◽  
Respiratory Support ◽  
Arterial Oxygen ◽  
Target Range ◽  
Care Providers ◽  
Manual Adjustment ◽  
Fraction Of Inspired Oxygen ◽  
Dynamic Adaptability ◽  
Inspired Oxygen

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.

Psychophysiological Responses of Pilots in Hypoxia Training at 7000 and 7500 m

2020 ◽  
Vol 91 (10) ◽  
pp. 785-789
Author(s):  
Dongqing Wen ◽  
Lei Tu ◽  
Guiyou Wang ◽  
Zhao Gu ◽  
Weiru Shi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Psychomotor Performance ◽  
Physiological Responses ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Awareness Training ◽  
Similar Frequency ◽  
Psychophysiological Responses ◽  
The Mean ◽  
Training Protocol

INTRODUCTION: We compared the physiological responses, psychomotor performances, and hypoxia symptoms between 7000 m and 7500 m (23,000 and 24,600 ft) exposure to develop a safer hypoxia training protocol.METHODS: In altitude chamber, 66 male pilots were exposed to 7000 and 7500 m. Heart rate and arterial oxygen saturation were continuously monitored. Psychomotor performance was assessed using the computational task. The hypoxic symptoms were investigated by a questionnaire.RESULTS: The mean duration time of hypoxia was 323.0 56.5 s at 7000 m and 218.2 63.3 s at 7500 m. The 6-min hypoxia training was completed by 57.6% of the pilots and 6.1% of the pilots at 7000 m and at 7500 m, respectively. There were no significant differences in pilots heart rates and psychomotor performance between the two exposures. The Spo2 response at 7500 m was slightly severer than that at 7000 m. During the 7000 m exposure, pilots experienced almost the same symptoms and similar frequency order as those during the 7500 m exposure.CONCLUSIONS: There were concordant symptoms, psychomotor performance, and very similar physiological responses between 7000 m and 7500 m during hypoxia training. The results indicated that 7000-m hypoxia awareness training might be an alternative to 7500-m hypoxia training with lower DCS risk and longer experience time.Wen D, Tu L, Wang G, Gu Z, Shi W, Liu X. Psychophysiological responses of pilots in hypoxia training at 7000 and 7500 m. Aerosp Med Hum Perform. 2020; 91(10):785789.

Outcomes of the Extracardiac Fontan Procedure Using Cardiopulmonary Bypass: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 173 ◽  
Author(s):  
Murat Ugurlucan ◽  
Eylem Yayla Tuncer ◽  
Fusun Guzelmeric ◽  
Eylul Kafali ◽  
Omer Ali Sayin ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Fontan Procedure ◽  
Fontan Operation ◽  
Arterial Oxygen Saturation ◽  
Vena Cava ◽  
Arterial Oxygen ◽  
Shunt Operation ◽  
Early Results ◽  
The Mean ◽  
Extracardiac Fontan

<p><strong>Background</strong>: Although the avoidance of cardiopulmonary bypass during the Fontan procedure has potential advantages, using cardiopulmonary bypass during this procedure has no adverse effects in terms of morbidity and mortality rates. In this study, we assessed the postoperative outcomes of our first 9 patients who have undergone extracardiac Fontan operation by the same surgeon using cardiopulmonary bypass.</p><p><strong>Methods</strong>: Between September 2011 and April 2013,  9 consecutive patients (3 males and 6 females) underwent extra-cardiac Fontan operation. All operations were performed under cardiopulmonary bypass at normothermia by the same surgeon.  The age of patients ranged between 4 and 17 (9.8 ± 4.2) years. Previous operations performed on these patients were modified Blalock-Taussig shunt procedure in 2 patients, bidirectional cavopulmonary shunt operation in 6 patients, and pulmonary arterial banding in 1 patient. Except 2 patients who required intracardiac intervention, cross-clamping was not applied. In all patients, the extracardiac Fontan procedure was carried out by interposing an appropriately sized tube graft between the infe-rior vena cava and right pulmonary artery.</p><p><strong>Results</strong>: The mean intraoperative Fontan pressure and transpulmonary gradient were 12.3 ± 2.5 and 6.9 ± 2.2 mm Hg, respectively. Intraoperative fenestration was not required. There was no mortality and 7 patients were discharged with-out complications. Complications included persistent pleural effusion in 1 patient and a transient neurological event in 1 patient. All patients were weaned off mechanical ventila-tion within 24 hours. The mean arterial oxygen saturation increased from 76.1% ± 5.3% to 93.5% ± 2.2%. All patients were in sinus rhythm postoperatively. Five patients required blood and blood-product transfusions. The mean intensive care unit and hospital stay periods were 2.9 ± 1.7 and 8.2 ±  1.9 days, respectively.</p><p><strong>Conclusions</strong>: The extracardiac Fontan operation per-formed using cardiopulmonary bypass provides satisfactory results in short-term follow-up and is associated with favor-able postoperative hemodynamics and morbidity rates.</p>

scholarly journals Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years’ retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xu Ma ◽  
Bing Jie ◽  
Dong Yu ◽  
Ling-Ling Li ◽  
Sen Jiang
Keyword(s):  
Arteriovenous Malformations ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Pulmonary Arteriovenous Malformations ◽  
Imaging Data ◽  
Peripheral Lung ◽  
Life Threatening ◽  
The Mean

Abstract Background The life-threatening haemorrhagic complications of pulmonary arteriovenous malformations (PAVMs) are extremely rare, and only described in isolated cases. This study was designed to comprehensively investigate management of ruptured PAVMs. Methods We retrospectively assessed clinical and imaging data of ruptured PAVMs to summarize incidence, clinical characteristics, and outcomes following embolisation between January 2008 and January 2021. Results Eighteen of 406 (4.4%) patients with PAVMs developed haemorrhagic complications. Twelve of 18 patients were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT). Haemorrhagic complications occurred with no clear trigger in all cases. Eight of 18 patients (44.4%) were initially misdiagnosed or had undergone early ineffective treatment. 28 lesions were detected, with 89.3% of them located in peripheral lung. Computed tomography angiography (CTA) showed indirect signs to indicate ruptured PAVMs in all cases. Lower haemoglobin concentrations were associated with the diameter of afferent arteries in the ruptured lesions. Successful embolotherapy was achieved in all cases. After embolotherapy, arterial oxygen saturation improved and bleeding was controlled (P < 0.05). The mean follow-up time was 3.2 ± 2.5 years (range, 7 months to 10 years). Conclusions Life threatening haemorrhagic complications of PAVMs are rare, they usually occur without a trigger and can be easily misdiagnosed. HHT and larger size of afferent arteries are major risk factors of these complications. CTA is a useful tool for diagnosis and therapeutic guidance for ruptured PAVMs. Embolotherapy is an effective therapy for this life-threatening complication.

scholarly journals Accuracy of Pulse Oximetry in the Presence of Fetal Hemoglobin—A Systematic Review

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 361
Author(s):  
Ena Pritišanac ◽  
Berndt Urlesberger ◽  
Bernhard Schwaberger ◽  
Gerhard Pichler
Keyword(s):  
Pulse Oximetry ◽  
Neonatal Intensive Care ◽  
English Language ◽  
Arterial Oxygen Saturation ◽  
Fetal Hemoglobin ◽  
Arterial Oxygen ◽  
Cochrane Library ◽  
Preterm Neonates ◽  
Neonatal Blood ◽  
The Impact

Continuous monitoring of arterial oxygen saturation by pulse oximetry (SpO2) is the main method to guide respiratory and oxygen support in neonates during postnatal stabilization and after admission to neonatal intensive care unit. The accuracy of these devices is therefore crucial. The presence of fetal hemoglobin (HbF) in neonatal blood might affect SpO2 readings. We performed a systematic qualitative review to investigate the impact of HbF on SpO2 accuracy in neonates. PubMed/Medline, Embase, Cumulative Index to Nursing & Allied Health database (CINAHL) and Cochrane library databases were searched from inception to January 2021 for human studies in the English language, which compared arterial oxygen saturations (SaO2) from neonatal blood with SpO2 readings and included HbF measurements in their reports. Ten observational studies were included. Eight studies reported SpO2-SaO2 bias that ranged from −3.6%, standard deviation (SD) 2.3%, to +4.2% (SD 2.4). However, it remains unclear to what extent this depends on HbF. Five studies showed that an increase in HbF changes the relation of partial oxygen pressure (paO2) to SpO2, which is physiologically explained by the leftward shift in oxygen dissociation curve. It is important to be aware of this shift when treating a neonate, especially for the lower SpO2 limits in preterm neonates to avoid undetected hypoxia.

Pulse Oximetry: An Alternative Method for the Assessment of Oxygenation in Newborn Infants

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 524-528
Author(s):  
Michael S. Jennis ◽  
Joyce L. Peabody
Keyword(s):  
Pulse Oximetry ◽  
Pulse Oximeter ◽  
Arterial Oxygen Saturation ◽  
Newborn Infants ◽  
Fetal Hemoglobin ◽  
Arterial Oxygen ◽  
Skin Injury ◽  
Reliable Technique ◽  
Arterial Blood

Continuous monitoring of oxygenation in sick newborns is vitally important. However, transcutaneous Po2 measurements have a number of limiations. Therefore, we report the use of the pulse oximeter for arterial oxygen saturation (Sao2) determination in 26 infants (birth weights 725 to 4,000 g, gestational ages 24 to 40 weeks, and postnatal ages one to 49 days). Fetal hemoglobin determinations were made on all infants and were repeated following transfusion. Sao2, readings from the pulse oximeter were compared with the Sao2 measured in vitro on simultaneously obtained arterial blood samples. The linear regression equation for 177 paired measurements was: y = 0.7x + 27.2; r = .9. However, the differences between measured Sao2 and the pulse oximeter Sao2 were significantly greater in samples with &gt; 50% fetal hemoglobin when compared with samples with &lt; 25% fetal hemoglobin (P &lt; .001). The pulse oximeter was easy to use, recorded trends in oxygenation instantaneously, and was not associated with skin injury. We conclude that pulse oximetry is a reliable technique for the continuous, noninvasive monitoring of oxygenation in newborn infants.

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