Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy.
Pediatr Pulmonol. 2019 Mar;54(3):358-363. doi: 10.1002/ppul.24238. Epub 2019 Jan 10.
The vast majority (95%) of very preterm infants receive oxygen-therapy monitored by oxygen pulse saturation (SpO ). However, they spend a significant percentage of time out of the SpO target with a high risk of severe complications such as bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP). Recently, systems allowing the automated control of inspired oxygen (FiO ) for patient delivery to maintain target SpO has been become commercially available. We reviewed literature and individuated sixteen studies on the effectiveness of automated control of FiO in preterm infants. These studies demonstrate that automated devices are significantly more effective than manual control in maintaining target SpO and in preventing hyperoxia, while they seem to be less effective in preventing hypoxia. The studies were very heterogeneous for design, population size, duration, and device used, and this precludes firm conclusions regarding effectiveness and best setting of these systems. Moreover, none of the studies investigated if automated control of FiO can actually improve outcome in preterm infants. We conclude that further large-scale studies are warranted to assess the actual clinical relevance of these devices and to decide if they should become the standard of care.
绝大多数（95%）极早产儿接受脉搏血氧饱和度（SpO ）监测的氧疗。然而，他们有很大一部分时间 SpO 不在目标范围内，存在严重并发症（如支气管肺发育不良（BPD）和早产儿视网膜病变（ROP））的高风险。最近，允许自动控制吸入氧（FiO ）以维持目标 SpO 的患者输送系统已商业化。我们复习了关于早产儿 FiO 自动控制效果的文献，确定了 16 项研究。这些研究表明，自动设备在维持目标 SpO 和预防高氧血症方面明显比手动控制更有效，而在预防低氧血症方面似乎效果较差。研究在设计、人群规模、持续时间和使用的设备方面非常不同，这使得关于这些系统的有效性和最佳设置无法得出明确的结论。此外，没有一项研究调查 FiO 自动控制是否可以改善早产儿的结局。我们得出结论，需要进一步开展大规模研究来评估这些设备的实际临床相关性，并决定它们是否应该成为护理标准。
