UNLABELLED: The utility of decision tree machine learning in exploring the interactions among the SpO2 target range, neonatal maturity, and oxemic-risk is demonstrated. METHODS: This observational study used 3 years of paired age-SpO2-PaO2 data from a neonatal ICU. The CHAID decision tree method was used to explore the interaction of postmenstrual age (PMA) on the risk of extreme arterial oxygen levels at six different potential SpO2 target ranges (88-92%, 89-93%, 90-94%, 91-95%, 92-96% and 93-97%). Risk was calculated using a severity-weighted average of arterial oxygen outside the normal range for neonates (50-80 mmHg). RESULTS: In total, 7500 paired data points within the potential target range envelope were analyzed. The two lowest target ranges were associated with the highest risk, and the ranges of 91-95% and 92-96% were associated with the lowest risk. There were shifts in the risk associated with PMA. All the target ranges showed the lowest risk at ≥42 weeks PMA. The lowest risk for preterm infants was within a target range of 92-96% with a PMA of ≤34 weeks. CONCLUSIONS: This study demonstrates the utility of decision tree analytics. These results suggest that SpO2 target ranges that are different from typical range might reduce morbidity and mortality. Further research, including prospective randomized trials, is warranted.
- Klíčová slova
- decision tree classification, hyperoxemic-risk, hypoxemic-risk, machine learning, neonatal, oxygen saturation targeting,
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The performance of automated control of inspired oxygen (A-FiO2) has been confirmed in dozens of studies but reports of routine use are limited. Broadly adopted in Poland, our aim is to share that experience. METHODS: We used a prospectively planned observational study of the performance, general use patterns, unit practices, and problems with A-FiO2, based on a web registry of case reports, complemented by surveys of subjective impressions. RESULTS: In 2019, a total of 92 A-FiO2 systems were in routine use in 38 centers. Of the 38 centers, 20 had agreed in 2013 to participate in the project. In these centers, A-FiO2 was applied in infants of all weights, but some centers restricted its use to weaning from oxygen and unstable infants. A cohort had reported their experience with each use (5/20 centers, 593 cases). A quarter of those infants were managed with a lower target range and three-quarters with alarms looser than European guidelines for manual SpO2 control. The perceived primary advantages of A-FiO2 were as follows: keeping the readings in the target range, reducing exposure to SpO2 extremes, reducing risk from nurse distraction, reducing workload, and reducing alarm fatigue. Practices did evolve with experience, including implementing changes in the alarm strategy, indications for use, and target range. The potential for over-reliance on automation was cited as a risk. There were a few reports of limited effectiveness (moderate 12/593 and poor 2/593). CONCLUSIONS: Automated oxygen control is broadly perceived by users as an improvement in controlling SpO2 with infrequent problems.
- Klíčová slova
- adoption of technology, automated oxygen control, neonatal care, oxygen control, routine use,
- Publikační typ
- časopisecké články MeSH
