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DOI: 10.1055/s-0034-1375617
Automated Adjustments of Inspired Fraction of Oxygen to Avoid Hypoxemia and Hyperoxemia in Neonates – A Systematic Review on Clinical Studies
Automatische Anpassung der inspiratorischen Sauerstofffraktion zur Vermeidung von Hypoxämie und Hyperoxämie bei Neugeborenen – Übersicht klinischer StudienPublication History
Publication Date:
10 July 2014 (online)
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Abstract
Supplemental oxygen is commonly provided during transition of neonates immediately after birth. Whereas an initial FiO2 of 0.21 is now recommended to stabilize full-term infants in the delivery room, the best FiO2 to start resuscitation of the very low birth weight infant (VLBWI) immediately after delivery is currently not known. Recent recommendations include the use of pulse oximetry to titrate the use of supplemental oxygen. As reference values for pulse oximetry during the first minutes of life have become available, automated FiO2-adjustments are feasible and may be very useful for delivery room care to limit oxygen exposure. Beyond neonatal transition, preterm infants in the neonatal intensive care unit (NICU) commonly require supplemental oxygen to avoid hypoxemia, especially VLBWI receiving respiratory support because of poor respiratory drive and/or lung disease. For respiratory care of newborn infants in the NICU automated FiO2-adjustment systems have been developed and have been studied in preterm infants for limited time frames using short-term physiological outcomes. These studies could demonstrate short-term benefits such as more stable arterial oxygen saturation. Recent clinical trials have shown that oxygen targeting may significantly affect mortality and morbidity. Therefore, randomized controlled trials are needed to study the effects of automated FiO2-adjustment on long-term outcomes to prove possible benefits on survival, the rate of retinopathy of prematurity and on neuro-developmental outcome.
Zusammenfassung
Bei Neugeborenen wird unmittelbar nach der Geburt häufig zusätzlich Sauerstoff verabreicht, um deren Anpassung zu unterstützen. Während für die Stabilisierung von reifen Neugeborenen im Kreißsaal ein initialer FiO2 von 0,21 empfohlen wird, ist die bestmögliche Sauerstofffraktion für sehr untergewichtige Frühgeborene (VLBWI) unmittelbar nach der Geburt derzeit unbekannt. Derzeit wird für Frühgeborene empfohlen, den FiO2 nach der pulsoximetrisch gemessenen arteriellen Sauerstoffsättigung zu steuern. Da inzwischen Referenzwerte für die Pulsoximetrie für die ersten Lebensminuten verfügbar sind, ist eine automatische FiO2-Anpassung technisch machbar und könnte helfen, die Verabreichung von Sauerstoff im Kreißsaal zu limitieren. Jenseits der Phase der Anpassung unmittelbar nach der Geburt benötigen Frühgeborene in der Neugeborenenintensivstation häufig zusätzlichen Sauerstoff um Hypoxämien zu vermeiden. Dies ist insbesondere bei VLBWI aufgrund des häufig reduzierten Atemantriebs und/oder aufgrund einer vorhandenen Lungenerkrankung notwendig. Inzwischen wurden automatische FiO2-Regler entwickelt und bei Frühgeborenen in Kurzzeitstudien mit physiologischen Zielkriterien klinisch untersucht. Diese Studien fanden günstige Effekte bei kurzfristigen Zielkriterien wie z. B. eine stabilere arterielle Sauerstoffsättigung innerhalb eines vorgewählten Zielbereichs. Neuere klinische Studien haben gezeigt, dass das Anstreben bestimmter Sauerstoffsättigungszielbereiche einen signifikanten Einfluss auf die Mortalität oder Morbidität hat. Daher sind randomisierte Studien notwendig, um die Effekte einer automatisierten FiO2-Anpassung auf langfristige Zielkriterien und deren Einfluss auf die Überlebensrate, auf die Rate an Frühgeborenenretinopathie oder auf die neurologische Entwicklung zu untersuchen.
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