SCO2T Study: A Randomised Crossover Study Comparing Pulse Oximeter Technology Using Automatic Oxygen Control for Preterm Infants
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 20
- 试验地点
- 2
- 主要终点
- Incidence of hyperoxia and hypoxia on saturation monitoring
研究概览
简要总结
Most premature babies require oxygen therapy. There is uncertainty about what oxygen levels are the best. The oxygen levels in the blood are measured using a monitor called a saturation monitor and the oxygen the baby breathes is adjusted to keep the level in a target range. Although there is evidence that lower oxygen levels maybe harmful, it is not known how high they need to be for maximum benefit. Very high levels are also harmful. Saturation monitors are not very good for checking for high oxygen levels. For this a different kind of monitor, called a transcutaneous monitor, is better.
Keeping oxygen levels stable is usually done by nurses adjusting the oxygen levels by hand (manual control). There is also equipment available that can do this automatically (servo control). It is not known which is best.
Research suggests that different automated devices control oxygen effectively as measured by the readings from their internal oxygen saturation monitoring systems. When compared to free-standing saturation monitors there appears to be variations in measured oxygen levels between devices. This could have important clinical implications.
This study aims to show the different achieved oxygen levels when babies are targeted to a set target range. Babies in the study will have both a saturation monitor and a transcutaneous oxygen monitor at the same time. Both types of monitor have been in long term use in neonatal units.
For a period of 12 hours, each baby will have their oxygen adjusted automatically using two different internal oxygen monitoring technologies (6 hours respectively). The investigators will compare the range of oxygen levels that are seen between the two oxygen saturation monitoring technologies.
The investigators will study babies born at less than 30 weeks gestation, who are at least 2 days old, on nasal high flow and still require added oxygen.
详细描述
Presently oxygen is titrated against saturation (SpO2) by manual adjustment. Automated or servo-control systems have been developed that result in tighter control of SpO2 and more time spent in the intended target range. These systems are already in clinical use. Automated systems produce quite large fluctuations in fraction of inspired oxygen (FiO2) in order to keep SpO2 in range. It is possible that this could result in short periods of high or low oxygen tension (PO2) that are undetectable using saturation monitoring. Studies to date have examined the effects of manual and automated (servo) oxygen targeting on SpO2 but not on transcutaneous oxygen tension (TcPO2).
Research suggests that individual servo control devices control oxygen effectively as measured by the readings obtained from their internal SpO2 monitoring system. The device the investigators intend to study is available with two different oximeter monitoring systems. When compared to a separate free-standing SpO2 monitor the devices have a systematic bias in the clinically targeted range. Consequently, this could allow variations between infants in oxygenation large enough to influence important clinical outcome to go unrecognised.
There is a need to determine the achieved SpO2 and TcPO2 distributions associated with the use of different automated control systems as a first step in planning future trials. When this is measured over a small number of hours it is not anticipated that this would have an influence on clinical outcome.
This study is a prospective, single centre, randomised crossover trial of two different internal oximeter monitoring systems in an automated (servo) control device - IntellO2 (Vapotherm, USA) - delivering nasal high flow employing automated oxygen titration. Each infant will act as their own control. Infants born at less than 30 weeks gestation, greater than 48 hour of age and receiving supplementary oxygen will be eligible for inclusion.
The study will be undertaken in the Neonatal Unit at the Simpson Centre for Reproductive Health at the Royal Infirmary of Edinburgh.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- None
盲法说明
commence on either Masimo oximetry or Nellcor oximetry using the Oxygen Assist Module (OAM), IntellO2 Vapotherm device. SpO2 (range 90-95%) will be continuously monitored on a second pulse oximetry probe connected to a bedside multiparameter monitor as per normal standard of care.
To remove selection bias the 20 infants will be randomised using sealed, windowless, envelopes. Half will instruct to commence on automated control (Precision Flow technology IntellO2, Vapotherm, USA) using Masimo oximetry technology to target SpO2 to 90-95%. Half will have instructions to commence on automated control (Precision Flow technology IntellO2, Vapotherm, USA) using Nellcor oximetry technology to target SpO2 to 90-95%.
入排标准
- 年龄范围
- 2 Days 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Infants born at less than 30 weeks gestation
- •Infants greater than 48 hours of age
- •Infants who are receiving supplementary oxygen
- •Person with parental responsibility able to give consent
排除标准
- •Congenital anomalies that would prevent targeting SpO2 to 90-95% (e.g. cardiac defects)
- •Clinical condition of an infant would impair accurateTcPO2 measurement (e.g. impaired perfusion or requirement of inotropic or vasopressor support)
- •Parent/person with parental responsibility unable to give informed consent on behalf of the infant
- •Infants born less than 22 weeks gestation
结局指标
主要结局
Incidence of hyperoxia and hypoxia on saturation monitoring
时间窗: 12 hours
To discover the percentage time spent within target SpO2 range of 90-95% when infants are targeted to an SpO2 range of 90-95% with an automated (servo) control device using two internal oximeter monitoring systems (Masimo and Nellcor).
次要结局
- Fraction of inspired oxygen variability(12 hours)
- Pooled frequency histogram of FiO2(12 hours)
- Pooled frequency histogram of SpO2(12 hours)
- Pooled frequency histogram of TcPO2(12 hours)
- Transcutaneous oxygen variability(12 hours)
- Desaturations(12 hours)
- Saturation variability(12 hours)