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=9

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=<sec><title>Introduction</title><p>We aimed to compare automated ventilation with closed–loop control of the fraction of inspired oxygen (FiO<sub>2</sub>) to automated ventilation with manual titrations of the FiO<sub>2</sub> with respect to time spent in predefined pulse oximetry (SpO<sub>2</sub>) zones in pediatric critically ill patients.</p></sec><sec><title>Methods</title><p>This was a randomized crossover clinical trial comparing Adaptive Support Ventilation (ASV) 1.1 with use of a closed–loop FiO<sub>2</sub> system vs. ASV 1.1 with manual FiO<sub>2</sub> titrations. The primary endpoint was the percentage of time spent in optimal SpO<sub>2</sub> zones. Secondary endpoints included the percentage of time spent in acceptable, suboptimal and unacceptable SpO<sub>2</sub> zones, and the total number of FiO<sub>2</sub> changes per patient.</p></sec><sec><title>Results</title><p>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 SpO<sub>2</sub> zones increased with use of the closed–loop FiO<sub>2</sub> controller vs. manual oxygen control [96.1 (93.7–98.6) vs. 78.4 (51.3–94.8); <italic>P</italic> &lt; 0.001]. The percentage of time spent in acceptable, suboptimal and unacceptable zones decreased. Findings were similar with the use of closed-loop FiO<sub>2</sub> controller compared to manual titration in patients with ARDS [95.9 (81.6–98.8) vs. 78 (49.5–94.8) %; <italic>P</italic> = 0.027]. The total number of closed-loop FiO<sub>2</sub> changes per patient was 52 (11.8–67), vs. the number of manual changes 1 (0–2), (<italic>P</italic> &lt; 0.001).</p></sec><sec><title>Conclusion</title><p>In this randomized crossover trial in pediatric critically ill patients under invasive ventilation with ASV, use of a closed–loop control of FiO<sub>2</sub> titration increased the percentage of time spent within in optimal SpO<sub>2</sub> zones, and increased the total number of FiO<sub>2</sub> changes per patient.</p></sec><sec><title>Clinical trial registration</title><p><ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, identifier: NCT04568642.</p></sec>