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 (FiO ₂ ) control to target oxygen saturation (SpO ₂ ) 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Embase, CENTRAL, and CINAHL from inception upto December 2016, reviewed conference proceedings and sought results of unpublished trials.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 FiO ₂ 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 SpO ₂ range. Summary mean differences (MD) were computed using random effects model. Results: Out of 276 identified studies 10 met the inclusion criteria. Automated FiO ₂ control significantly improved time being spent within the target SpO ₂ range [MD: 12.8%; 95% CI: 6.5-19.2%; I ² = 90%]. Periods of hyperoxia (MD:-8.8%; 95% CI: -15 to -2.7%), severe hypoxia(SpO ₂ < 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 FiO ₂ adjustment provides significant improvement of time in target saturations, reduces periods of hyperoxia, and severe hypoxia in preterm infants on positive pressure respiratory support.