CROSSOVER FROM AUTOMATED TO MANUAL TITRATION OF FiO2 IN THE NICU: IS THERE A TRANSITION LAG?

Effective management of oxygenation of preterm infants in critical care profoundly impacts their outcome. Nurses are challenged to titrate the inspired oxygen in response to constant cardiopulmonary instability. Closed loop control of inspired oxygen based on continuous monitoring of oxygen saturation is just becoming available. Evaluating the relative effectiveness of closed loop control systems is complicated by the wide variability in manual control by nurses. This analysis explored the possibility of a lag in effective control associated with the transition from closed loop to manual control using data from a clinical crossover trial. A short but marked lag phase was detected. It is, however, unlikely to have impact on clinical care or crossover studies. Its presence highlights the anticipative nature of closed loop control as contrasted to the observative nature of manual control