Automated control of fraction of inspired oxygen: is it time for widespread adoption?

Purpose of review Over the past two decades, numerous algorithms for automated control of the fraction of inspired oxygen (FiO(2)) have been developed and incorporated into contemporary neonatal ventilators and high-flow devices in an attempt to optimize supplemental oxygen therapy in preterm infants. This review explores whether current evidence is sufficient to recommend widespread adoption of automated oxygen control in neonatal care. Recent findings To date, 15 studies have compared automated versus manual control of FiO(2) in preterm infants on respiratory support. This includes four new randomized cross-over trials published in the last 2 years. Available evidence consistently demonstrates a significant improvement in time spent within the target saturation range with automated FiO(2) control. There are fewer episodes of severe hypoxemia and fewer manual FiO(2) adjustments with automated oxygen control. Nursing workload may be reduced. However, no currently completed studies report on clinical outcomes, such as chronic lung disease or retinopathy of prematurity. Automated oxygen control appears to be a reasonable option for FiO(2) titration in preterm infants on respiratory support, if resources are available, and might substantially reduce nursing workload. Further randomized clinical trials to explore its effects on clinical outcomes are required.

Automated summary

Automated oxygen control for FiO2 titration in preterm infants on respiratory support is a reasonable option, providing significant improvement in time spent within the target saturation range, reducing episodes of severe hypoxemia, and decreasing nursing workload. However, there is currently no research reporting its impact on clinical outcomes.