Dataset Information
Evaluation of two SpO2 alarm strategies during automated FiO2 control in the NICU: a randomized crossover study.
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ABSTRACT: Background
Changes in oxygen saturation (SpO2) exposure have been shown to have a marked impact on neonatal outcomes and therefore careful titration of inspired oxygen is essential. In routine use, however, the frequency of SpO2 alarms not requiring intervention results in alarm fatigue and its corresponding risk. SpO2 control systems that automate oxygen adjustments (Auto-FiO2) have been shown to be safe and effective. We speculated that when using Auto-FiO2, alarm settings could be refined to reduce unnecessary alarms, without compromising safety.Methods
An unblinded randomized crossover study was conducted in a single NICU among infants routinely managed with Auto-FiO2. During the first 6?days of respiratory support a tight and a loose alarm strategy were switched each 24?h. A balanced block randomization was used. The tight strategy set the alarms at the prescribed SpO2 target range, with a 30-s delay. The loose strategy set the alarms 2 wider, with a 90-s delay. The effectiveness outcome was the frequency of SpO2 alarms, and the safety outcomes were time at SpO2 extremes (?98%). We hypothesized that the loose strategy would result in a marked decrease in the frequency of SpO2 alarms, and no increases at SpO2 extremes with 20 subjects. Within subject differences between alarm strategies for the primary outcomes were evaluated with Wilcoxon signed-rank test.Results
During a 13-month period 26 neonates were randomized. The analysis included 21 subjects with 49?days of both tight and loose intervention. The loose alarm strategy resulted in a reduction in the median rate of SpO2 alarms from 5.2 to 1.6 per hour (p?ConclusionsIn this group of infants we found a marked advantage of the looser alarm strategy. We conclude that the paradigms of alarm strategies used for manual titration of oxygen need to be reconsidered when using Auto-FiO2. We speculate that with optimal settings false positive SpO2 alarms can be minimized, with better vigilance of clinically relevant alarms.Trial registration
Retrospectively registered 15 May 2018 at ISRCTN ( 49239883 ).
SUBMITTER: Warakomska M
PROVIDER: S-EPMC6501373 | biostudies-literature | 2019 May
REPOSITORIES: biostudies-literature
Publications
Evaluation of two SpO<sub>2</sub> alarm strategies during automated FiO<sub>2</sub> control in the NICU: a randomized crossover study.
BMC pediatrics 20190506 1
<h4>Background</h4>Changes in oxygen saturation (SpO<sub>2</sub>) exposure have been shown to have a marked impact on neonatal outcomes and therefore careful titration of inspired oxygen is essential. In routine use, however, the frequency of SpO<sub>2</sub> alarms not requiring intervention results in alarm fatigue and its corresponding risk. SpO<sub>2</sub> control systems that automate oxygen adjustments (Auto-FiO<sub>2</sub>) have been shown to be safe and effective. We speculated that when ...[more]