Association of extreme hyperoxemic events and mortality in pediatric critical care: an observational cohort study.

Objective: Our aim was to confirm whether extreme hyperoxemic events had been associated with excess mortality in our diverse critical care population.

Methods: Retrospective analysis of 9 years of data collected in the pediatric and cardiothoracic ICUs in Children's Hospital Los Angeles was performed. The analysis was limited to those mechanically ventilated for at least 24 h, with at least 1 arterial blood gas measurement.

Performance and safety of the PRICO closed-loop oxygen saturation targeting system in neonates: pragmatic multicentre cross-over study (TarOx Study).

Objective: This study aims to evaluate the performance of the fabian-Predictive-Intelligent-Control-of-Oxygenation (PRICO) system for automated control of the fraction of inspired oxygen (FiO).

Design: Multicentre randomised cross-over study.

Setting: Five neonatal intensive care units experienced with automated control of FiO and the fabian ventilator.

Evaluation of Leading Smartwatches for the Detection of Hypoxemia: Comparison to Reference Oximeter.

Although smartwatches are not considered medical devices, experimental validation of their accuracy in detecting hypoxemia is necessary due to their potential use in monitoring conditions manifested by a prolonged decrease in peripheral blood oxygen saturation (SpO), such as chronic obstructive pulmonary disease, sleep apnea syndrome, and COVID-19, or at high altitudes, e.g., during sport climbing, where the use of finger-sensor-based pulse oximeters may be limited.

Determining an Optimal Oxygen Saturation Target Range Based on Neonatal Maturity: Demonstration of a Decision Tree Analytic.

Unlabelled: The utility of decision tree machine learning in exploring the interactions among the SpO target range, neonatal maturity, and oxemic-risk is demonstrated.

Methods: This observational study used 3 years of paired age-SpO-PaO data from a neonatal ICU. The CHAID decision tree method was used to explore the interaction of postmenstrual age (PMA) on the risk of extreme arterial oxygen levels at six different potential SpO target ranges (88-92%, 89-93%, 90-94%, 91-95%, 92-96% and 93-97%).

Prolonged use of closed-loop inspired oxygen support in preterm infants: a randomised controlled trial.

Objective: This randomised study in preterm infants on non-invasive respiratory support investigated the effectiveness of automated oxygen control (A-FiO) in keeping the oxygen saturation (SpO) within a target range (TR) during a 28-day period compared with manual titration (M-FiO).

Design: A single-centre randomised control trial.

Setting: A level III neonatal intensive care unit.

Randomised control trial of oxygen assist module in preterm infants on high-flow nasal cannula support.

Objective: To evaluate the efficacy of automatic oxygen control (A-FiO) in reducing the extremes of oxygen saturations (SpO<80% and SpO>98%) in preterm infants on high-flow nasal cannula (HFNC) respiratory support using Vapotherm Precision Flow.

Design: A parallel-arm randomised controlled trial.

Setting: A level-III neonatal intensive care unit.

Reducing the time delay of oxygen transport to the neonate on continuous positive airway pressure support: A bench study.

Background: Premature newborns often require oxygen support as part of their therapy. Systems for oxygen administration are developed to assure adequate oxygenation of newborns. Several factors were identified in the systems that contribute to the time delay between the change in the set inspiratory oxygen fraction and its actual delivery to tissues.

Commercial smartwatch with pulse oximeter detects short-time hypoxemia as well as standard medical-grade device: Validation study.

Objective: We investigated how a commercially available smartwatch that measures peripheral blood oxygen saturation (SpO) can detect hypoxemia compared to a medical-grade pulse oximeter.

Methods: We recruited 24 healthy participants. Each participant wore a smartwatch (Apple Watch Series 6) on the left wrist and a pulse oximeter sensor (Masimo Radical-7) on the left middle finger.

Automatic oxygen control for reducing extremes of oxygen saturation: a randomised controlled trial.

Objective: The objective of this study was to evaluate the efficacy of the automatic oxygen control (A-Fio) in reducing the percentage of time spent in severe hypoxaemia (Spo <80%) in preterm infants for the time period on invasive ventilation and/or nasal continuous positive airway pressure (NCPAP) delivered by AVEA ventilator.

Design: A parallel arm randomised controlled trial.

Setting: A level-III neonatal intensive care unit.

Automated Oxygen Delivery in Neonatal Intensive Care.

Oxygen is the most common drug used in the neonatal intensive care. It has a narrow therapeutic range in preterm infants. Too high (hyperoxemia) or low oxygen (hypoxemia) is associated with adverse neonatal outcomes.

Comparison of volume guarantee and volume-controlled ventilation both using closed loop inspired oxygen in preterm infants: a randomised crossover study (CLIO-VG study).

Objective: The objective of this study was to compare two different modes of ventilation in maintaining oxygen saturation (SpO2) in target range (90%-95%) in ventilated preterm infants cared for with automatic control of oxygen delivery (A-FiO2).

Design: A single-centre randomised crossover study.

Settings: A level III neonatal intensive care unit.

Thresholds for oximetry alarms and target range in the NICU: an observational assessment based on likely oxygen tension and maturity.

Background: Continuous monitoring of SpO in the neonatal ICU is the standard of care. Changes in SpO exposure have been shown to markedly impact outcome, but limiting extreme episodes is an arduous task. Much more complicated than setting alarm policy, it is fraught with balancing alarm fatigue and compliance.

Evaluation of two SpO alarm strategies during automated FiO control in the NICU: a randomized crossover study.

Background: Changes in oxygen saturation (SpO) exposure have been shown to have a marked impact on neonatal outcomes and therefore careful titration of inspired oxygen is essential. In routine use, however, the frequency of SpO alarms not requiring intervention results in alarm fatigue and its corresponding risk. SpO control systems that automate oxygen adjustments (Auto-FiO) have been shown to be safe and effective.

Hypoxemic and hyperoxemic likelihood in pulse oximetry ranges: NICU observational study.

Objective: Describe the likelihood of hypoxemia and hyperoxemia across ranges of oxygen saturation (SpO), during mechanical ventilation with supplemental oxygenation.

Design: Retrospective observational study.

Setting: University affiliated tertiary care neonatal intensive care unit.

Severity of Hypoxemia and Effect of High-Frequency Oscillatory Ventilation in Acute Respiratory Distress Syndrome.

Rationale: High-frequency oscillatory ventilation (HFOV) is theoretically beneficial for lung protection, but the results of clinical trials are inconsistent, with study-level meta-analyses suggesting no significant effect on mortality.

Objectives: The aim of this individual patient data meta-analysis was to identify acute respiratory distress syndrome (ARDS) patient subgroups with differential outcomes from HFOV.

Methods: After a comprehensive search for trials, two reviewers independently identified randomized trials comparing HFOV with conventional ventilation for adults with ARDS.

USING THE AUTOMATED FIO2- SPO2 CONTROL IN NEONATAL INTENSIVE CARE UNITS IN POLAND. A PRELIMINARY REPORT.

Aim: Analysis of the way in which a new method of implementing the automated control of oxygen therapy during respiratory support is applied in newborns with respiratory failure.

Material, Methods And Results: The AVEA-CLiO2 ventilator with automated FiO2- SpO2 control was used in our study of 121 newborns conducted between February 2014 and January 2015 in five neonatal intensive care units. A web-based database was used to gather information entered concurrently with using the FiO2- SpO2 control system.

THE CONSEQUENCES OF FAILING ELECTIVE NONINVASIVE RESPIRATORY SUPPORT AS COMPARED TO IMMEDIATE INTUBATION: A POPULATION STUDY OF VERY LOW BIRTH WEIGHT NEONATES.

Introduction: Elective noninvasive respiratory support has become common. However, many neonates fail this procedure and they may require intubation. The aim of this study was to determine the relative outcome of very low birth weight neonates who failed noninvasive respiratory support compared to those that were initially intubated and mechanically ventilated.

Quicker response results in better SpO2 control - a comparison of 3 FiO2-titration strategies in ventilated preterm infants.

Introduction: The impact of SpO2 target ranges (TR) has been carefully studied; however, reports suggest a wide variation among infants and centres in maintaining the intended range. Little is known about the effectiveness of different approaches to manual control. Auto-SpO2 controllers are now available which show promise.

High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury: A Multicenter International Experience.

Objective: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice.

Design: Multicenter retrospective, observational questionnaire study.

Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants.

Objective: To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO2) in maintaining arterial oxygen saturation (SpO2) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants.

Study Design: Eighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO2 target ranges and then treated with automated FiO2 (A-FiO2) and manual FiO2 (M-FiO2) oxygen control for 24 hours each, in random sequence.

Results: The percent time within the target range was higher during A-FiO2 compared with M-FiO2 control.

Automated FiO2-SpO2 control system in neonates requiring respiratory support: a comparison of a standard to a narrow SpO2 control range.

Background: Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Changes in target ranges have been shown to significantly impact mortality and morbidity. Selecting and implementing the optimal target range are complicated not only by issues of training, but also the realities of staffing levels and demands.

A multicenter randomized controlled trial comparing effectiveness of two nasal continuous positive airway pressure devices in very-low-birth-weight infants.

Objective: Many studies suggest nasal continuous positive airway pressure is an effective and relatively complication-free means of respiratory support in premature infants. However, only limited data exist regarding the practical aspects of nasal continuous positive airway pressure delivery, including the best way to provide the positive airway pressure.

Design: Our aim was to compare the results of treatment using two different nasal continuous positive airway pressure devices: variable flow Infant Flow and constant flow nasal continuous positive airway pressure in two different groups of very-low-birth-weight infants in a multicenter randomized controlled trial.