AUTHOR=Soydan Ekin , Ceylan Gokhan , Topal Sevgi , Hepduman Pinar , Atakul Gulhan , Colak Mustafa , Sandal Ozlem , Sari Ferhat , Karaarslan Utku , Novotni Dominik , Schultz Marcus J. , Agin Hasan 

TITLE=Automated closed–loop FiO2 titration increases the percentage of time spent in optimal zones of oxygen saturation in pediatric patients–A randomized crossover clinical trial

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.969218

DOI=10.3389/fmed.2022.969218

ISSN=2296-858X

ABSTRACT=Introduction:
 We aimed to compare automated ventilation with closed–loop control of the fraction of inspired oxygen (FiO2) to automated ventilation with manual titrations of the FiO2 with respect to time spent in predefined pulse oximetry (SpO2) zones in pediatric critically ill patients.
Methods:
 This was a randomized crossover clinical trial comparing Adaptive Support Ventilation (ASV) 1.1 with use of a closed–loop FiO2 system versus ASV 1.1 with manual FiO2 titrations. The primary endpoint was the percentage of time spent in optimal SpO2 zones. Secondary endpoints included the percentage of time spent in acceptable, suboptimal and unacceptable SpO2 zones, and the total number of FiO2 changes per patient.
Results:
 We included 30 children with a median age of 21 [11–48] months; 12 (40%) children had pediatric ARDS. The percentage of time spent in optimal SpO2 zones increased with use of the closed–loop FiO2 controller versus (96.1 [93.7–98.6] versus 78.4 [51.3–94.8]; P < 0.001). The percentage of time spent in acceptable, suboptimal and unacceptable zones improved. Findings were similar in patients with ARDS (95.9 [81.6–98.8] versus 78 [49.5–94.8] %; P = 0.027), and in patients with PEEP was ≥ 10 cm H2O (94.8 [86.8–97.4] versus 92.4 [48.4–96.1] %; P = 0.031). The total number of closed- loop FiO2 changes per patient was 52 [11.8–67], versus the number of manual changes 1 [0–2], (P <0.001).
Conclusion:
 In this randomized crossover trial in pediatric critically ill patients under invasive ventilation with ASV, use of a closed–loop control of FiO2 control increased the percentage of time spent within in optimal SpO2 zones, and increased the total number of FiO2 changes per patient.