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SCO2T (Servo vs. Servo)

Primary Purpose

Premature Infant, Oxygen Therapy, Hypoxia

Status
Terminated
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
Servo control (closed-loop automatic control of the inspiratory fraction of oxygen (FiO2)) - Leoni plus CLAC
Servo control (closed-loop automatic control of the inspiratory fraction of oxygen (FiO2)) - IntellO2 OAM
Sponsored by
University of Edinburgh
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Premature Infant focused on measuring Servo Control, Close-Loop Automated Oxygen Control

Eligibility Criteria

2 Days - undefined (Child, Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Infants born at less than 30 weeks gestation
  2. Infants greater than 48 hours of age
  3. Infants who are receiving supplementary oxygen
  4. Person with parental responsibility able to give consent

Exclusion Criteria:

  1. Congenital anomalies that would prevent targeting SpO2 to 90-95% (e.g. cardiac defects)
  2. Clinical condition of an infant would impair accurateTcPO2 measurement (e.g. impaired perfusion or requirement of inotropic or vasopressor support)

Sites / Locations

  • The Simpson Centre for Reproductive Health, Royal Infirmary Edinburgh

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Servo control - Leoni plus CLAC

Servo control - IntellO2 Precision Flow, Vapotherm

Arm Description

Automated control of oxygen. The oxygen saturation target range will be set to 90-95% as per standard practice. Automated oxygen control can be overridden by manual adjustment of oxygen at any time if this is considered necessary to optimise control of oxygenation according to current clinical targets.

Automated control of oxygen. The oxygen saturation target range will be set to 90-95% (set to maintain an integral value of 93%) as per standard practice. Automated oxygen control can be overridden by manual adjustment of oxygen at any time if this is considered necessary to optimise control of oxygenation according to current clinical targets.

Outcomes

Primary Outcome Measures

Incidence of hyperoxia and hypoxia on transcutaneous monitoring
To discover the percentage time spent within a TcPO2 range of 50mmHg (6.7kPa) - 80mmHg (10.7kPa) when infants are targeted to an SpO2 range of 90-95% using two automated (servo) control devices (Leoni plus CLAC and Vapotherm IntellO2) delivering nasal high flow.

Secondary Outcome Measures

Transcutanous oxygen variability
To discover the variability in TcPO2 (measured by standard deviation) when infants are targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Incidence of hyperoxia and hypoxia on saturation monitoring
To discover the percentage time spent within target SpO2 range of 90-95% when infants are targeted using the two automated (servo) control devices delivering nasal high flow.
Saturation variability
To discover the variability in SpO2 (measured by standard deviation) when infants are targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Fraction of inspired oxygen variability
To discover the variability in FiO2 (measured by standard deviation) when infants are targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Pooled frequency histogram of TcPO2
To generate a pooled frequency histogram of percentage time at a TcPO2 of below 30mmHg, 30-39.9mmHg, 40-49.9mmHg, 50-59.9mmHg, 60-69.9mmHg, 70-79.9mmHg, and 80mmHg and above for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Pooled frequency histogram of SpO2
To generate a pooled frequency histogram of percentage time at each SpO2 point between 80 - 100% for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Pooled frequency histogram of FiO2
To generate a pooled frequency histogram of the cumulative frequency at a FiO2 of 0.21-0.3, 0.31-0.4, 0.41-0.5, 0.51-0.6, 0.61-0.7, 0.81-0.9 and 0.91-1.0 for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Desaturations
To discover the frequency, duration and depth of desaturations and the area (change in PO2 versus time) above and below the set PO2 threshold for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.

Full Information

First Posted
September 4, 2020
Last Updated
May 31, 2023
Sponsor
University of Edinburgh
Collaborators
NHS Lothian
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1. Study Identification

Unique Protocol Identification Number
NCT04546568
Brief Title
SCO2T (Servo vs. Servo)
Official Title
Servo Controlled Oxygen Targeting (SCO2T): Servo Versus Servo
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Terminated
Why Stopped
Failed to meet recruitment target
Study Start Date
August 10, 2020 (Actual)
Primary Completion Date
May 3, 2023 (Actual)
Study Completion Date
May 3, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Edinburgh
Collaborators
NHS Lothian

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
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. Studies of automated control have shown that infants spend more time within their intended target oxygen saturation range. These have not included measurements of transcutaneous oxygen. There are no previous studies directly comparing automated respiratory devices. The investigators aim to show the transcutaneous oxygen levels as well as the oxygen saturation levels when babies have their oxygen adjusted using two automated (servo) control devices delivering nasal high flow. For a period of 12 hours each baby will have their oxygen adjusted automatically using each devices for 6 hours respectively. The investigators will compare the range of oxygen levels that are seen between the two respiratory devices.
Detailed Description
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). There are no studies directly comparing two automated systems. 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 automated (servo) control devices - IntellO2 (Vapotherm, USA) versus Leoni plus CLAC (Löwenstein Medical, Germany) - 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. Total study time is 12 hours for each infant. Infants will be randomised to commence on either automated (servo) control using either Leoni plus CLAC or IntellO2, Vapotherm. SpO2 (range 90-95%) will be continuously monitored as per normal standard of care. A second pulse oximetry probe will be place for servo control input. Additional monitoring will be carried out as shown below: TcPO2 monitoring FiO2 monitoring Heart rate monitoring (used to validate SpO2 readings) Arterial gas sampling (only if conducted by the direct care team as part of the routine care of the infant; no extra blood samples will be taken as part of the study) FiO2 will be adjusted by the respiratory support devices which have integrated automated oxygen control, set to maintain a SpO2 target range of 90-95%. The IntellO2 device uses Precision Flow technology (IntellO2, Vapotherm, USA). By means of a modified closed-loop algorithm, the devise uses Masimo pulse oximetry to target a user-set SpO2 value. The Leoni plus CLAC (Closed-Loop Automated oxygen Control) ventilator (Leoni plus, Löwenstein Medical, Germany) similarly uses MasimoSET (Signal Extraction Technology) to target SpO2 and automate oxygen control. Both devices have a signal averaging time of 8 seconds (Masimo, Irvine, USA). The Leoni plus CLAC algorithm is set to a 30 seconds wait time between adjustments, allowing up to 120 automated adjustments/hour. SpO2 readings will be downloaded directly from the multiparameter patient monitor. SpO2 will be measured using a Phillips MX500 multiparameter monitor (Phillips, Germany, CE 0366). TcPO2 will be measured using a SenTec Digital Monitoring System with OxiVent sensor (SenTec AG, Switzerland, European patent No. 1535055, CE 0120). Both monitors are routinely used in clinical practice. Transcutaneous data will be recorded contemporaneously and the site of the transcutaneous probe will be rotated on each infant every 2 hours. Control of sensor temperature and application duration are designed to meet all applicable standards and this monitoring device is use routinely in many neonatal units.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Premature Infant, Oxygen Therapy, Hypoxia, Hyperoxia, Obstetric Labor, Premature
Keywords
Servo Control, Close-Loop Automated Oxygen Control

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
This is a randomised cross-over study of servo-controlled oxygen targeting in premature infants, with infants acting as their own controls
Masking
None (Open Label)
Masking Description
This study is randomised but not blinded. Infants will be randomised to commence on either automated (servo) control using either Leoni plus CLAC or IntellO2, Vapotherm. SpO2 (range 90-95%) will be continuously monitored 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 (servo) control using Leoni plus CLAC (Leoni plus, Löwenstein Medical, Germany) to target SpO2 to 90-95%, and half will have instructions to commence on automated (servo) control using IntellO2 Precision Flow (IntellO2, Vapotherm, USA).
Allocation
Randomized
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Servo control - Leoni plus CLAC
Arm Type
Experimental
Arm Description
Automated control of oxygen. The oxygen saturation target range will be set to 90-95% as per standard practice. Automated oxygen control can be overridden by manual adjustment of oxygen at any time if this is considered necessary to optimise control of oxygenation according to current clinical targets.
Arm Title
Servo control - IntellO2 Precision Flow, Vapotherm
Arm Type
Active Comparator
Arm Description
Automated control of oxygen. The oxygen saturation target range will be set to 90-95% (set to maintain an integral value of 93%) as per standard practice. Automated oxygen control can be overridden by manual adjustment of oxygen at any time if this is considered necessary to optimise control of oxygenation according to current clinical targets.
Intervention Type
Device
Intervention Name(s)
Servo control (closed-loop automatic control of the inspiratory fraction of oxygen (FiO2)) - Leoni plus CLAC
Intervention Description
FiO2 adjustments will be made by the Leoni plus CLAC (Closed-Loop Automated oxygen Control) ventilator (Leoni plus, Löwenstein Medical, Germany). Manual adjustments of the inspired oxygen fraction can additionally be made as per standard care.
Intervention Type
Device
Intervention Name(s)
Servo control (closed-loop automatic control of the inspiratory fraction of oxygen (FiO2)) - IntellO2 OAM
Intervention Description
FiO2 adjustments will be made by the IntellO2 Oxygen Assist Module (OAM) for Precision Flow (IntellO2, Vapotherm, USA). Manual adjustments of the inspired oxygen fraction can additionally be made as per standard care.
Primary Outcome Measure Information:
Title
Incidence of hyperoxia and hypoxia on transcutaneous monitoring
Description
To discover the percentage time spent within a TcPO2 range of 50mmHg (6.7kPa) - 80mmHg (10.7kPa) when infants are targeted to an SpO2 range of 90-95% using two automated (servo) control devices (Leoni plus CLAC and Vapotherm IntellO2) delivering nasal high flow.
Time Frame
12 hours
Secondary Outcome Measure Information:
Title
Transcutanous oxygen variability
Description
To discover the variability in TcPO2 (measured by standard deviation) when infants are targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours
Title
Incidence of hyperoxia and hypoxia on saturation monitoring
Description
To discover the percentage time spent within target SpO2 range of 90-95% when infants are targeted using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours
Title
Saturation variability
Description
To discover the variability in SpO2 (measured by standard deviation) when infants are targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours
Title
Fraction of inspired oxygen variability
Description
To discover the variability in FiO2 (measured by standard deviation) when infants are targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours
Title
Pooled frequency histogram of TcPO2
Description
To generate a pooled frequency histogram of percentage time at a TcPO2 of below 30mmHg, 30-39.9mmHg, 40-49.9mmHg, 50-59.9mmHg, 60-69.9mmHg, 70-79.9mmHg, and 80mmHg and above for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours
Title
Pooled frequency histogram of SpO2
Description
To generate a pooled frequency histogram of percentage time at each SpO2 point between 80 - 100% for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours
Title
Pooled frequency histogram of FiO2
Description
To generate a pooled frequency histogram of the cumulative frequency at a FiO2 of 0.21-0.3, 0.31-0.4, 0.41-0.5, 0.51-0.6, 0.61-0.7, 0.81-0.9 and 0.91-1.0 for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours
Title
Desaturations
Description
To discover the frequency, duration and depth of desaturations and the area (change in PO2 versus time) above and below the set PO2 threshold for infants targeted to an SpO2 range of 90-95% using the two automated (servo) control devices delivering nasal high flow.
Time Frame
12 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Days
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: 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 Exclusion Criteria: 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)
Facility Information:
Facility Name
The Simpson Centre for Reproductive Health, Royal Infirmary Edinburgh
City
Edinburgh
State/Province
City Of Edinburgh
ZIP/Postal Code
EH16 4SA
Country
United Kingdom

12. IPD Sharing Statement

Learn more about this trial

SCO2T (Servo vs. Servo)

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