OBJECTIVE: To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (Fio₂) adjustment in maintaining arterial oxygen saturation (Spo₂) within an intended range for mechanically ventilated preterm infants with frequent episodes of decreased Spo₂. METHODS: Thirty-two infants (gestational age [median and interquartile range]: 25 weeks [24–27 weeks]; age: 27 days [17–36 days]) were studied during 2 consecutive 24-hour periods, one with Fio₂ adjusted by clinical staff members (manual) and the other by an automated system (automated), in random sequence. RESULTS: Time with Spo₂ within the intended range (87%–93%) increased significantly during the automated period, compared with the manual period (40% ± 14% vs 32% ± 13% [mean ± SD]). Times with Spo₂ of >93% or >98% were significantly reduced during the automated period (21% ± 20% vs 37% ± 12% and 0.7% vs 5.6% [interquartile ranges: 0.1%–7.2% and 2.7%–11.2%], respectively). Time with Spo₂ of <87% increased significantly during the automated period (32% ± 12% vs 23% ± 9%), with more-frequent episodes with Spo₂ between 80% and 86%, whereas times with Spo₂ of <80% or <75% did not differ between periods. Hourly median Fio₂ values throughout the automated period were lower and there were substantially fewer manual Fio₂ changes (10 ± 9 vs 112 ± 59 changes per 24 hours; P < .001), compared with the manual period. CONCLUSIONS: In infants with fluctuations in Spo₂, automated Fio₂ adjustment improved maintenance of the intended Spo₂ range led to reduced time with high Spo₂ and more-frequent episodes with Spo₂ between 80% and 86%.

Rationale: High-frequency oscillatory ventilation (HFOV) is theoretically beneficial for lung protection, but the results of clinical trials are inconsistent, with study-level meta-analyses suggesting no significant effect on mortality. Objectives: The aim of this individual patient data meta-analysis was to identify acute respiratory distress syndrome (ARDS) patient subgroups with differential outcomes from HFOV. Methods: After a comprehensive search for trials, two reviewers independently identified randomized trials comparing HFOV with conventional ventilation for adults with ARDS. Prespecified effect modifiers were tested using multivariable hierarchical logistic regression models, adjusting for important prognostic factors and clustering effects. Measurements and Main Results: Data from 1,552 patients in four trials were analyzed, applying uniform definitions for study variables and outcomes. Patients had a mean baseline PaO2/FiO2 of 114 ± 39 mm Hg; 40% had severe ARDS (PaO2/FiO2 <100 mm Hg). Mortality at 30 days was 321 of 785 (40.9%) for HFOV patients versus 288 of 767 (37.6%) for control subjects (adjusted odds ratio, 1.17; 95% confidence interval, 0.94–1.46; P = 0.16). This treatment effect varied, however, depending on baseline severity of hypoxemia (P = 0.0003), with harm increasing with PaO2/FiO2 among patients with mild-moderate ARDS, and the possibility of decreased mortality in patients with very severe ARDS. Compliance and body mass index did not modify the treatment effect. HFOV increased barotrauma risk compared with conventional ventilation (adjusted odds ratio, 1.75; 95% confidence interval, 1.04–2.96; P = 0.04). Conclusions: HFOV increases mortality for most patients with ARDS but may improve survival among patients with severe hypoxemia on conventional mechanical ventilation.

Objective: To evaluate the effect of implementing automated oxygen control as routine care in maintaining oxygen saturation (SpO₂) within target range in preterm infants. Methods: Infants <30 weeks gestation in Leiden University Medical Centre before and after the implementation of automated oxygen control were compared. The percentage of time spent with SpO₂ within and outside the target range (90–95%) was calculated. SpO₂ values were collected every minute and included for analysis when infants received extra oxygen. Results: In a period of 9 months, 42 preterm infants (21 manual, 21 automated) were studied. In the automated period, the median (IQR) time spent with SpO₂ within target range increased (manual vs automated: 48.4 (41.5–56.4)% vs 61.9 (48.5–72.3)%; p95% decreased (41.9 (30.6–49.4)% vs 19.3 (11.5–24.5)%; p<0.001). The time SpO₂<90% increased (8.6 (7.2–11.7)% vs 15.1 (14.0–21.1)%; p<0.0001), while SpO₂<80% was similar (1.1 (0.4–1.7)% vs 0.9 (0.5–2.1)%; ns). Conclusions: During oxygen therapy, preterm infants spent more time within the SpO₂ target range after implementation of automated oxygen control, with a significant reduction in hyperoxaemia, but not hypoxaemia.

We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice. Multicenter retrospective, observational questionnaire study. Seven PICUs. Demographic, disease factor, and ventilatory and outcome data were collected, and 328 patients from 2009 to 2010 were included in this analysis. None. Patients were classified into six cohorts based on underlying diagnosis. We used univariate analysis to identify factors associated with mortality risk and multivariate logistic regression to identify independent predictors of mortality risk. An oxygenation index greater than 35 and immunocompromise exhibited the greatest predictive power (p < 0.0001) for increased mortality risk, and respiratory syncytial virus was associated with lowest mortality risk (p = 0.003). Differences in mortality risk as a function of oxygenation index were highly dependent on primary underlying condition. A trend toward an increase in oscillator amplitude and frequency was observed when compared with historical data. Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.

Although smartwatches are not considered medical devices, experimental validation of their accuracy in detecting hypoxemia is necessary due to their potential use in monitoring conditions manifested by a prolonged decrease in peripheral blood oxygen saturation (SpO₂), such as chronic obstructive pulmonary disease, sleep apnea syndrome, and COVID-19, or at high altitudes, e.g., during sport climbing, where the use of finger-sensor-based pulse oximeters may be limited. The aim of this study was to experimentally compare the accuracy of SpO₂ measurement of popular smartwatches with a clinically used pulse oximeter according to the requirements of ISO 80601-2-61. Each of the 18 young and healthy participants underwent the experimental assessment three times in randomized order—wearing Apple Watch 8, Samsung Galaxy Watch 5, or Withings ScanWatch—resulting in 54 individual experimental assessments and complete datasets. The accuracy of the SpO₂ measurements was compared to that of the Radical-7 (Masimo Corporation, Irvine, CA, USA) during short-term hypoxemia induced by consecutive inhalation of three prepared gas mixtures with reduced oxygen concentrations (14%, 12%, and 10%). All three smartwatch models met the maximum acceptable root-mean-square deviation (≤4%) from the reference measurement at both normal oxygen levels and induced desaturation with SpO₂ less than 90%. Apple Watch 8 reached the highest reliability due to its lowest mean bias and root-mean-square deviation, highest Pearson correlation coefficient, and accuracy in detecting hypoxemia. Our findings support the use of smartwatches to reliably detect hypoxemia in situations where the use of standard finger pulse oximeters may be limited.