Ventilator Lung; Newborn Clinical Trial
Official title:
Automatic Oxygen Control (SPOC) in Preterm Infants - Evaluation of a Revised Algorithm and Effect of Averaging Time of Pulse Oximetry Signal
Single-center, randomised controlled, cross-over clinical trial in preterm infants born at
gestational age below 34+1/7 weeks receiving supplemental oxygen and respiratory support
(continous positive airway pressure (CPAP) or non-invasive ventilation (NIV) or invasive
ventilation (IV)). Routine manual control (RMC) of the fraction of inspired oxygen (FiO2)
will be tested against RMC supported by automatic control (SPOC) with "old"-algorithm and RMC
supported by CLAC with "new"-algorithm.
The first primary hypothesis is, that the use of the "new" algorithm results in more time
within arterial oxygen saturation (SpO2) target range compared to RMC only. The a-priori
subordinate hypothesis is, that the new algorithm results in more time within SpO2 target
range compared to SPOCold.
The second primary hypothesis is, that the use of 2 seconds averaging time of the SpO2 Signal
results in more time within arterial oxygen saturation (SpO2) target range compared to the
use of 8 seconds averaging interval of the SpO2 signal.
BACKGROUND AND OBJECTIVE In preterm infants receiving supplemental oxygen, routine manual
control (RMC) of the fraction of inspired oxygen (FiO2) is often difficult and time
consuming. The investigators developed a system for closed-loop automatic control (SPOC) of
the FiO2. The objective of this study is to test a revised, "new" algorithm with 3 adaptions
against the former "old" algorithm and against RMC. The 3 adaptions are:
1. Faster re-adjustment to baseline-FiO2 (baseline FiO2: mean FiO2 during the previous
5min)
2. Delayed reduction of FiO2 below baseline FiO2
3. Maximum FiO2 adjustable by user
The first primary hypothesis is, that the application of SPOCnew in addition to RMC results
in more time within arterial oxygen saturation (SpO2) target range compared to RMC only. The
a-priori subordinate hypothesis is, that the revised algorithm is more effective as the old
algorithm to maintain the SpO2 in the target range.
The second primary hypothesis is, that the shortening of averaging time used for the SpO2
Signal from 8 seconds to 2 seconds results in more time within SpO2 target range for both,
SPOCnew and SPOCold.
Further hypotheses for exploratory testing are, that the SPOC new algorithm will achieve a
lower proportion of time with SpO2 above and below the target range, hyper- and hypoxia and
an improved stability of cerebral oxygenation (measured as rcStO2 and rcFtO2E determined by
Near-infrared spectroscopy) compared with SPOCold and RMC. Reduction of staff workload
(estimated by number of manual adjustments per hour) by SPOC. Validation of a clinical
scoring tool to monitor severity of apnea of prematurity.
STUDY DESIGN The Study is designed as a single-center, randomized controlled, cross-over
clinical trial in preterm infants receiving mechanical ventilation or nasal continuous
positive airway pressure or non-invasive ventilation and supplemental oxygen (FiO2 above
0.21). Within a 30-hour period the investigators will compare 6 hours of RMC with 12-hour
periods of RMC supported by SPOCnew algorithm or SPOCold algorithm, respectively. During
intervals with SPOC control the SpO2 Signal averaging time will be 2 second or 8seconds ,
respectively, for 6 hours each.
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