Comparison of two devices for automated oxygen control in preterm infants: a randomised crossover trial

Objective To compare the effect of two different automated oxygen control devices on target range (TR) time and occurrence of hypoxaemic and hyperoxaemic episodes.Design Randomised cross-over study.Setting Tertiary level neonatal unit in the Netherlands.Patients Preterm infants (n=15) born between 24+0 and 29+6 days of gestation, receiving invasive or non-invasive respiratory support with oxygen saturation (SpO(2)) TR of 91%-95%. Median gestational age 26 weeks and 4 days (IQR 25 weeks 3days-27 weeks 6 days) and postnatal age 19 (IQR 17-24) days.Interventions Inspired oxygen concentration was titrated by the OxyGenie controller (SLE6000 ventilator) and the CLIO2 controller (AVEA ventilator) for 24 hours each, in a random sequence, with the respiratory support mode kept constant.Main outcome measures Time spent within set SpO(2) TR (91%-95% with supplemental oxygen and 91%-100% without supplemental oxygen).Results Time spent within the SpO(2) TR was higher during OxyGenie control (80.2 (72.6-82.4)% vs 68.5 (56.7-79.3)%, p<0.005). Less time was spent above TR while in supplemental oxygen (6.3 (5.1-9.9)% vs 15.9 (11.5-30.7)%, p<0.005) but more time spent below TR during OxyGenie control (14.7 (11.8%-17.2%) vs 9.3 (8.2-12.6)%, p<0.05). There was no significant difference in time with SpO(2) <80% (0.5 (0.1-1.0)% vs 0.2 (0.1-0.4)%, p=0.061). Long-lasting SpO(2) deviations occurred less frequently during OxyGenie control.Conclusions The OxyGenie control algorithm was more effective in keeping the oxygen saturation within TR and preventing hyperoxaemia and equally effective in preventing hypoxaemia (SpO(2) <80%), although at the cost of a small increase in mild hypoxaemia.Developmen

On Traversable Lorentzian Wormholes in the Vacuum Low Energy Effective String Theory in Einstein and Jordan Frames

Three new classes (II-IV) of solutions of the vacuum low energy effective string theory in four dimensions are derived. Wormhole solutions are investigated in those solutions including the class I case both in the Einstein and in the Jordan (string) frame. It turns out that, of the eight classes of solutions investigated (four in the Einstein frame and four in the corresponding string frame), massive Lorentzian traversable wormholes exist in five classes. Nontrivial massless limit exists only in class I Einstein frame solution while none at all exists in the string frame. An investigation of test scalar charge motion in the class I solution in the two frames is carried out by using the Plebanski-Sawicki theorem. A curious consequence is that the motion around the extremal zero (Keplerian) mass configuration leads, as a result of scalar-scalar interaction, to a new hypothetical "mass" that confines test scalar charges in bound orbits, but does not interact with neutral test particles.Comment: 18 page

Clinical outcomes of preterm infants while using automated controllers during standard care: comparison of cohorts with different automated titration strategies

Objective To compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2). Design Propensity score-matched retrospective observational study. Setting Tertiary-level neonatal unit in the Netherlands. Patients Preterm infants (OxyGenie n=121, CLiO2 n=121) born between 24+0-29+6 weeks of gestation. Median (IQR) gestational age in the OxyGenie cohort was 28+3 (26+3.5-29+0) vs 27+5 (26+5-28+3) in the CLiO2 cohort, respectively 42% and 46% of infants were male and mean (SD) birth weight was 1034 (266) g vs 1022 (242) g. Interventions Inspired oxygen was titrated by OxyGenie (SLE6000) or CLiO2 (AVEA) during respiratory support. Main outcome measures Mortality, retinopathy of prematurity (ROP), bronchopulmonary dysplasia and necrotising enterocolitis. Results Fewer infants in the OxyGenie group received laser coagulation for ROP (1 infant vs 10; risk ratio 0.1 (95% CI 0.0 to 0.7); p=0.008), and infants stayed shorter in the neonatal intensive care unit (NICU) (28 (95% CI 15 to 42) vs 40 (95% CI 25 to 61) days; median difference 13.5 days (95% CI 8.5 to 19.5); p<0.001). Infants in the OxyGenie group had fewer days on continuous positive airway pressure (8.4 (95% CI 4.8 to 19.8) days vs 16.7 (95% CI 6.3 to 31.1); p<0.001) and a significantly shorter days on invasive ventilation (0 (95% CI 0 to 4.2) days vs 2.1 (95% CI 0 to 8.4); p=0.012). There were no statistically significant differences in all other morbidities. Conclusions In this propensity score-matched retrospective study, the OxyGenie epoch was associated with less morbidity when compared with the CLiO2 epoch. There were significantly fewer infants that received treatment for ROP, received less intensive respiratory support and, although there were more supplemental oxygen days, the duration of stay in the NICU was shorter. A larger study will have to replicate these findings.This study compared the outcomes of matched cohorts of preterm infants who were treated using 2 different automated oxygen controllers. Differences in morbidity were observed. The data suggest that it cannot be assumed that different automated controllers will produce similar results and that randomised controlled trials will be necessary to refine their use appropriately.Ophthalmic researc

Clinical outcomes of preterm infants while using automated controllers during standard care: comparison of cohorts with different automated titration strategies

Objective: To compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2). Design: Propensity score-matched retrospective observational study. Setting: Tertiary-level neonatal unit in the Netherlands. Patients: Preterm infants (OxyGenie n=121, CLiO2 n=121) born between 24+0-29+6 weeks of gestation. Median (IQR) gestational age in the OxyGenie cohort was 28+3 (26+3.5-29+0) vs 27+5 (26+5-28+3) in the CLiO2 cohort, respectively 42% and 46% of infants were male and mean (SD) birth weight was 1034 (266) g vs 1022 (242) g. Interventions: Inspired oxygen was titrated by OxyGenie (SLE6000) or CLiO2 (AVEA) during respiratory support. Main outcome measures: Mortality, retinopathy of prematurity (ROP), bronchopulmonary dysplasia and necrotising enterocolitis. Results: Fewer infants in the OxyGenie group received laser coagulation for ROP (1 infant vs 10; risk ratio 0.1 (95% CI 0.0 to 0.7); p=0.008), and infants stayed shorter in the neonatal intensive care unit (NICU) (28 (95% CI 15 to 42) vs 40 (95% CI 25 to 61) days; median difference 13.5 days (95% CI 8.5 to 19.5); p<0.001). Infants in the OxyGenie group had fewer days on continuous positive airway pressure (8.4 (95% CI 4.8 to 19.8) days vs 16.7 (95% CI 6.3 to 31.1); p<0.001) and a significantly shorter days on invasive ventilation (0 (95% CI 0 to 4.2) days vs 2.1 (95% CI 0 to 8.4); p=0.012). There were no statistically significant differences in all other morbidities. Conclusions:In this propensity score-matched retrospective study, the OxyGenie epoch was associated with less morbidity when compared with the CLiO2 epoch. There were significantly fewer infants that received treatment for ROP, received less intensive respiratory support and, although there were more supplemental oxygen days, the duration of stay in the NICU was shorter. A larger study will have to replicate these findings.This study compared the outcomes of matched cohorts of preterm infants who were treated using 2 different automated oxygen controllers. Differences in morbidity were observed. The data suggest that it cannot be assumed that different automated controllers will produce similar results and that randomised controlled trials will be necessary to refine their use appropriately.</p

Echocardiographic screening results in patients with tuberous sclerosis complex.

Contains fulltext : 88782.pdf (publisher's version ) (Closed access)We sought to examine the frequency of abnormal echocardiographic findings in patients with tuberous sclerosis complex. In a retrospective cohort study, we included all patients with known tuberous sclerosis complex who had been sent to our cardiology department for echocardiographic screening from 1995 through August 2003 (n=56). Two research scientists independently reviewed the reports of the echocardiographic screening examinations for abnormal findings. We used descriptive statistics, the Mann-Whitney U test, and the chi(2) test. The mean age of patients included in the study was 35 years (range, 12-73 yr); 23 patients were male. Abnormal findings were seen in 22 patients (39%). The most common abnormal findings were focal areas of increased intramyocardial echogenicity, which were seen in 16 patients (29%). The clinical consequence of this finding is still unknown. We conclude that echocardiographic abnormalities are common in patients with tuberous sclerosis complex