184 research outputs found
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Automated regulation of inspired oxygen in preterm infants: oxygenation stability and clinician workload
No full textPremature infants are at an increased risk of ophthalmic, neurologic, and respiratory sequelae related to inadequate maintenance of oxygenation and exposure to increased levels of inspired oxygen. Management of inspired oxygen is complicated in this population by an increased variability in oxygenation. Automated regulation of the fraction of inspired oxygen is a technology that has a potential of improving such outcomes as well as impacting personnel workload. This is a review of current experimental evidence on the effectiveness of automated regulation of inspired oxygen and its effects on oxygenation variability and personnel workload during the care of premature infants
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Closing the loop of mechanical respiratory support for preterm infants
No full textPremature infants require mechanical respiratory support to maintain adequate gas exchange, which consists of positive pressure ventilation and supplemental oxygen. However, the needed respiratory support often contributes to lung injury and other morbidity. Clinicians reduce the support to avert lung injury due to excessive and/or repeated lung inflation and oxygen toxicity. However, weaning is often delayed by fluctuations in ventilation and oxygenation due to instability of the respiratory system and spontaneous respiratory drive.This work included the development of a system for closed loop targeted minute ventilation (V'E) continuously that adjusts ventilator frequency to maintain a desired ventilation level, a system for closed loop targeted tidal volume (VT) that adjusts the ventilator pressure to generate a desired tidal volume, and a third controller that results from the combined application of these controllers in parallel.This work also involved development of a system for oxygenation targeted closed loop control of the fraction of inspired oxygen (FiO2). This system maintains oxygenation within an adequate range during fluctuations in oxygenation with the least FiO2.A clinical study showed the efficacy of closed loop targeted V 'E in reducing the ventilatory support, without adverse effects on gas exchange in a group of premature infants compared to conventional mechanical ventilation.In an animal study, closed loop targeted V' E and closed loop targeted VT were shown to be effective in maintaining ventilation and oxygenation in a rabbit model of apnea, reduced lung volume and respiratory system compliance. In this study, the combined controller was more effective than the individual components.A clinical study demonstrated the efficacy of the system for oxygenation targeted closed loop FiO2 control in maintaining oxygenation in a group of ventilated premature infants who presented with frequent and acute episodes of hypoxemia.In summary, this work documented the feasibility of closed loop control of mechanical respiratory support for premature infants. These techniques were effective in reducing the support and in maintaining ventilation and oxygenation by adapting to the changing needs of premature infants. This form of support may reduce the risk of lung injury and oxygen toxicity.</p
Quantification of Oxygenation Instability, Intermittent Hypoxemia Etiology, and Reliability of Pulse Oximetry for Detection of Hypoxemia in Extremely Premature Infants
No full textThe primary objective was to evaluate the reliability of pulse oximetry in detecting episodes of IH in the presence of motion by using measured SpO2 values and pulse plethysmograph waveforms from two pulse oximeters in the same infant for validation. The secondary objective is to determine the prevalence of the different mechanisms of Intermittent hypoxemia episodes in premature infants with advancing age. The tertiary objective was to develop an analytical tool to assess each infant's oxygenation instability, severity, frequency, and duration of intermittent hypoxemia episodes. This tool provided a non-subjective analysis of oxygenation instability in multiple site studies in the neonatology intensive care unit (NICU) for premature infants with underlying lung disease and immature respiratory systems. It further allowed for non-biased assessment in comparing the within-subject effect of the two target ranges of arterial oxygen saturation (SpO2) on ventilatory stability in premature infants of 23-28 weeks gestational age (GA). The optimized version of this tool was utilized to evaluate intermittent hypoxemia and hyperoxemia. A recommendation for further study is enclosed. </p
Automated Control of Oxygen in Neonates
No full textSupplemental oxygen is given to a large proportion of preterm infants to maintain adequate levels of oxygenation. In this population exposure to supplemental oxygen increases the risk of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and oxygen radical injury to other organs and systems (McColm and Fleck 2001; Tin and Gupta 2007; Saugstad 2003). These effects are more pronounced in infants born at earlier gestational ages due to their immaturity and the prolonged duration of the exposure to oxygen
Automated respiratory support in newborn infants
No full textA considerable proportion of premature infants requires mechanical ventilatory support and supplemental oxygen. Due to their immaturity, exposure to these forms of respiratory support contributes to the development of lung injury, oxidative stress and abnormal retinal development. These conditions are associated with poor long-term respiratory and neurological outcome. Mechanically ventilated preterm infants present with frequent fluctuations in ventilation and gas exchange. Currently available ventilatory modes and manual adjustment to the ventilator or supplemental oxygen cannot effectively adapt to these recurrent fluctuations. Moreover, the respiratory support often exceeds the infant's real needs. Techniques that adapt the mechanical ventilatory support and supplemental oxygen to the changing needs of preterm infants are being developed in order to improve stability of gas exchange, to minimise respiratory support and to reduce personnel workload. This article describes the preliminary evidence on the application of these new techniques in preterm infants and animal models
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