Document Detail


Closed loop control of inspired oxygen concentration in trauma patients.
MedLine Citation:
PMID:  19476833     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transport of mechanically ventilated patients in a combat zone presents challenges, including conservation of resources. In the battlefield setting, provision of oxygen supplies remains an important issue. Autonomous control of oxygen concentration can allow a reduction in oxygen usage and reduced mission weight.
METHODS: Trauma patients requiring ventilation and inspired oxygen concentration (FIO(2)) > 0.40 were evaluated for study. Patients were randomized to consecutive 4-hour periods of closed loop control or standard care. The system for autonomous control consisted of a ventilator, oximeter, and a portable computer. The computer housed the control algorithm and collected data every 5 seconds. The controller goal was to maintain pulse oximetry (SpO(2)) at 94 +/- 2% through discrete changes of 1% to 5% every 30 seconds. Ventilator settings and SpO(2) were recorded every 5 seconds for analysis.
RESULTS: Forty-five patients were enrolled in this study. Oxygen saturation was maintained in the 92% to 96% saturation range 33 +/- 36% of the time during clinician control versus 83 +/- 21% during closed loop control. Time spent at the target SpO(2) 92% to 96% was 193.3 +/- 59.18 minutes during closed loop control and 87.08 +/- 87.95 minutes during clinician control (p < 0.001). Hyperoxemia was more frequent during clinician control (144.29 +/- 90.09 minutes) than during closed loop control (38.91 +/- 55.86 minutes; p < 0.001). There were no differences in the number of episodes of SpO(2) < 88%. Oxygen usage was reduced by 32% during closed loop control.
CONCLUSION: Closed loop control of FIO(2) offers the opportunity for maximizing oxygen resources, reducing mission weight, and providing targeted normoxemia without increasing risk of hypoxemia in ventilated trauma patients.
Authors:
Jay A Johannigman; Richard D Branson; Michael G Edwards
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.; Retracted Publication     Date:  2009-03-26
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  208     ISSN:  1879-1190     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-29     Completed Date:  2009-06-18     Revised Date:  2011-10-10    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  763-8; discussion 768-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA. jay.johannigman@uc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anoxia / prevention & control
Carbon Dioxide / blood
Female
Humans
Injury Severity Score
Male
Middle Aged
Oximetry
Oxygen / administration & dosage*,  blood
Oxygen Inhalation Therapy / instrumentation,  methods*
Respiration, Artificial / methods*
Wounds and Injuries / blood,  therapy*
Young Adult
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comments/Corrections
Retraction In:
J Am Coll Surg. 2011 Sep;213(3):456   [PMID:  21871390 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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