Pulse oximetry signal loss during hypoxic episodes in preterm infants receiving automated oxygen control

Author:

Langanky Lukas O.,Kreutzer Karen B.ORCID,Poets Christian F.ORCID,Franz Axel R.ORCID,Schwarz Christoph E.ORCID

Abstract

AbstractThe aim of this study was to analyze signal loss (SL) resulting from low signal quality of pulse oximetry-derived hemoglobin oxygen saturation (SpO2) measurements during prolonged hypoxemic episodes (pHE) in very preterm infants receiving automatic oxygen control (AOC). We did a post hoc analysis of a randomized crossover study of AOC, programmed to set FiO2 to “back-up FiO2” during SL. In 24 preterm infants (median (interquartile range)) gestational age 25.3 (24.6 to 25.6) weeks, recording time 12.7 h (12.2 to 13.6 h) per infant, we identified 76 pHEs (median duration 119 s (86 to 180 s)). In 50 (66%) pHEs, SL occurred for a median duration of 51 s (33 to 85 s) and at a median frequency of 2 (1 to 2) SL-periods per pHE. SpO2 before and after SL was similar (82% (76 to 88%) vs 82% (76 to 87%), p = 0.3)).  Conclusion: SL is common during pHE and must hence be considered in AOC-algorithm designs. Administering a “backup FiO2” (which reflects FiO2-requirements during normoxemia) during SL may prolong pHE with SL.  Trial registration: The study was registered at www.clinicaltrials.gov under the registration no. NCT03785899. What is Known:• Previous studies examined SpO2 signal loss (SL) during routine manual oxygen control being rare, but pronounced in lower SpO2 states.• Oxygen titration during SL is unlikely to be beneficial as SpO2 may recover to a normoxic range. What is New:• Periods of low signal quality of SpO2 are common during pHEs and while supported with automated oxygen control (SPOC), FiO2 is set to a back-up value reflecting FiO2 requirements during normoxemia in response to SL, although SpO2 remained below target until signal recovery.• FiO2 overshoots following pHEs were rare during AOC and occurred with a delayed onset; therefore, increased FiO2 during SL does not necessarily lead to overshoots.

Funder

Universitätsklinikum Heidelberg

Publisher

Springer Science and Business Media LLC

Reference10 articles.

1. Schwarz CE, Kreutzer KB, Langanky L, Wolf NS, Braun W, O’Sullivan MP et al (2022) Randomised crossover trial comparing algorithms and averaging times for automatic oxygen control in preterm infants. Arch Dis Child Fetal Neonatal Ed 107(4):425–430. https://doi.org/10.1136/archdischild-2021-322096

2. Gajdos M, Waitz M, Mendler MR, Braun W, Hummler H (2019) Effects of a new device for automated closed loop control of inspired oxygen concentration on fluctuations of arterial and different regional organ tissue oxygen saturations in preterm infants. Arch Dis Child Fetal Neonatal Ed 104(4):F360–F365. https://doi.org/10.1136/archdischild-2018-314769

3. Mitra S, Singh B, El-Naggar W, McMillan DD (2018) Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis. J Perinatol 38(4):351–360. https://doi.org/10.1038/s41372-017-0037-z

4. Schwarz CE, Kidszun A, Bieder NS, Franz AR, Konig J, Mildenberger E et al (2020) Is faster better? A randomised crossover study comparing algorithms for closed-loop automatic oxygen control. Arch Dis Child Fetal Neonatal Ed 105(4):369–374. https://doi.org/10.1136/archdischild-2019-317029

5. Dargaville PA, Marshall AP, Ladlow OJ, Bannink C, Jayakar R, Eastwood-Sutherland C et al (2022) Automated control of oxygen titration in preterm infants on non-invasive respiratory support. Arch Dis Child Fetal Neonatal Ed 107(1):39–44. https://doi.org/10.1136/archdischild-2020-321538

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