title: Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs.
abstract: BACKGROUND
  Hyperoxia and hypoxia influence morbidity and mortality of preterm infants. Automated closed-loop control of the fraction of inspired oxygen (FiO(2)) has been shown to facilitate oxygen supplementation in the neonatal intensive care unit (NICU), but has not yet been tested during preterm resuscitation. We hypothesized that fully automated FiO(2) control based on predefined oxygen saturation (SpO(2)) targets was applicable in both preterm resuscitation and ventilation.
  
  
  METHODS
  Twenty-two preterm lambs were operatively delivered and intubated in a modified EXIT procedure. They were randomized to receive standardized resuscitation with either automated or manual FiO(2) control, targeting SpO(2) according to the Dawson curve in the first 10 min and SpO(2) 90-95% hereafter. Automated FiO(2) control also was applied during surfactant replacement therapy and subsequent ventilation.
  
  
  RESULTS
  Time within target range did not differ significantly between manual and automated FiO(2) control during resuscitation, however automated FiO(2) control significantly avoided hyperoxia. Automated FiO(2) control was feasible during surfactant replacement and kept SpO(2) within target range significantly better than manual control during subsequent ventilation.
  
  
  CONCLUSIONS
  In our model, fully automated FiO(2) control was feasible in rapidly changing physiologic conditions during postnatal resuscitation and prevented hyperoxia. We conclude that closed loop FiO(2) control is a promising tool for the delivery room.
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands.|Department of Pediatrics, Neonatology, University Clinic Medical Faculty RWTH Aachen, Aachen, Germany.
authors: Matthias C
authors: MC
authors: Hütten
authors: Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.|Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
authors: Tom G
authors: TG
authors: Goos
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands.
authors: Daan
authors: D
authors: Ophelders
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands.
authors: Maria
authors: M
authors: Nikiforou
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands.
authors: Elke
authors: E
authors: Kuypers
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors: Monique
authors: M
authors: Willems
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands.
authors: Hendrik J
authors: HJ
authors: Niemarkt
authors: Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
authors: Jenny
authors: J
authors: Dankelman
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands.|Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands.
authors: Peter
authors: P
authors: Andriessen
authors: Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands.
authors: Thilo
authors: T
authors: Mohns
authors: Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors: Irwin K M
authors: IK
authors: Reiss
authors: Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands.|Department of Pediatrics, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors: Boris W
authors: BW
authors: Kramer
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001331:Automation; D001688:Biological Products / Q000494:pharmacology; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D018496:Hyperoxia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007442:Intubation, Intratracheal; D008168:Lung / Q000187:drug effects / Q000196:embryology / Q000503:physiopathology*; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000379:methods*; D010743:Phospholipids / Q000494:pharmacology; D011247:Pregnancy; D047928:Premature Birth; D011663:Pulmonary Surfactants / Q000494:pharmacology; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D012756:Sheep; D013997:Time Factors
chemical_list: D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa