Objective To study the feasibility of automated titration of oxygen therapy in the delivery room for preterm infants.
Design Prospective non-randomised study of oxygenation in sequential preterm cohorts in which FiO2 was adjusted manually or by an automated control algorithm during the first 10 min of life.
Setting Delivery rooms of a tertiary level hospital.
Participants Preterm infants <32 weeks gestation (n=20 per group).
Intervention Automated oxygen control using a purpose-built device, with SpO2 readings input to a proportional-integral-derivative algorithm, and FiO2 alterations actuated by a motorised blender. The algorithm was developed via in silico simulation using abstracted oxygenation data from the manual control group. For both groups, the SpO2 target was the 25th–75th centile of the Dawson nomogram.
Main outcome measures Proportion of time in the SpO2 target range (25th–75th centile, or above if in room air) and other SpO2 ranges; FiO2 adjustment frequency; oxygen exposure.
Results Time in the SpO2 target range was similar between groups (manual control: median 60% (IQR 48%–72%); automated control: 70 (60–84)%; p=0.31), whereas time with SpO2 >75th centile when receiving oxygen differed (manual: 17 (7.6–26)%; automated: 10 (4.4–13)%; p=0.048). Algorithm-directed FiO2 adjustments were frequent during automated control, but no manual adjustments were required in any infant once valid SpO2 values were available. Oxygen exposure was greater during automated control, but final FiO2 was equivalent.
Conclusion Automated oxygen titration using a purpose-built algorithm is feasible for delivery room management of preterm infants, and warrants further evaluation.
- intensive care units
Data availability statement
Data are available on reasonable request.
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Contributors SKMA: conceived the study and gained funding (with PAD and TJG), conducted the study, compiled and analysed the data, wrote the first draft of the manuscript and approved the final version. RJ: was involved in the tuning, simulation testing and implementation of the VDL-DR1.0 algorithm, reviewed and edited the manuscript and approved the final version. APM: was involved in the tuning, simulation testing and implementation of the VDL-DR1.0 algorithm, reviewed and edited the manuscript and approved the final version. TJG: conceived the study and gained funding (with SKMA and PAD), was involved in the tuning, simulation testing and implementation of the VDL-DR1.0 algorithm, reviewed and edited the manuscript and approved the final version. PAD: conceived the study and gained funding (with SKMA and TJG), was involved in the tuning, simulation testing and implementation of the VDL-DR1.0 algorithm, conducted the study, analysed the data, reviewed and edited the manuscript, approved the final version, and takes responsibility for the content as the study guarantor.
Funding This study was supported by a grant (15-101) from the Royal Hobart Hospital Research Foundation.
Competing interests The University of Tasmania holds a patent concerning a method, apparatus and system for automatically controlling inspired oxygen delivery. An oxygen control algorithm (VDL1.1) has been incorporated as the OxyGenie automated oxygen titration system in the SLE6000 infant ventilator (SLE, South Croydon, UK).
Provenance and peer review Not commissioned; externally peer reviewed.
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