Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review of clinical trials comparing automated versus manual fraction of inspired oxygen (FiO2 ) control to target oxygen saturation (SpO2 ) in preterm infants.

DESIGN: The authors searched MEDLINE, Embase, CENTRAL, and CINAHL from inception upto December 2016, reviewed conference proceedings and sought results of unpublished trials. Studies were included if automated FiO2 control was compared to manual control in preterm infants on positive pressure respiratory support. The primary outcome was percentage of time spent within the target SpO2 range. Summary mean differences (MD) were computed using random effects model.

RESULTS: Out of 276 identified studies 10 met the inclusion criteria. Automated FiO2 control significantly improved time being spent within the target SpO2 range [MD: 12.8%; 95% CI: 6.5-19.2%; I2  = 90%]. Periods of hyperoxia (MD:-8.8%; 95% CI: -15 to -2.7%), severe hypoxia(SpO2   < 80%)(MD: -0.9%;95%CI: -1.5 to -0.4%) and hypoxic events (MD: -5.6%; 95% CI: -9.1 to -2.1%) were significantly reduced with automated control.

CONCLUSION: Automated FiO2 adjustment provides significant improvement of time in target saturations, reduces periods of hyperoxia, and severe hypoxia in preterm infants on positive pressure respiratory support.