title: Clinical evaluation of a novel adaptive algorithm for automated control of oxygen therapy in preterm infants on non-invasive respiratory support.
abstract: OBJECTIVE
  To evaluate the performance of a novel rapidly responsive proportional-integral-derivative (PID) algorithm for automated oxygen control in preterm infants with respiratory insufficiency.
  
  
  METHODS
  Interventional study of a 4-hour period of automated oxygen control compared with combined data from two flanking periods of manual control (4 hours each).
  
  
  METHODS
  Neonatal intensive care unit.
  
  
  METHODS
  Preterm infants (n=20) on non-invasive respiratory support and supplemental oxygen, with oxygen saturation (SpO2) target range 90%-94% (manual control) and 91%-95% (automated control). Median gestation at birth 27.5 weeks (IQR 26-30 weeks), postnatal age 8.0 (1.8-34) days.
  
  
  METHODS
  Automated oxygen control using a standalone device, receiving SpO2input from a standard oximeter and computing alterations to oxygen concentration that were actuated with a modified blender. The PID algorithm was enhanced to avoid iatrogenic hyperoxaemia and adapt to the severity of lung dysfunction.
  
  
  METHODS
  Proportion of time in the SpO2target range, or above target range when in air.
  
  
  RESULTS
  Automated oxygen control resulted in more time in the target range or above in air (manual 56 (48-63)% vs automated 81 (76-90)%, p<0.001) and less time at both extremes of oxygenation. Prolonged episodes of hypoxaemia and hyperoxaemia were virtually eliminated. The control algorithm showed benefit in every infant. Manual changes to oxygen therapy were infrequent during automated control (0.24/hour vs 2.3/hour during manual control), and oxygen requirements were unchanged (automated control period 27%, manual 27% and 26%, p>0.05).
  
  
  CONCLUSIONS
  The novel PID algorithm was very effective for automated oxygen control in preterm infants, and deserves further investigation.
authors: Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.|School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors: Gemma K
authors: GK
authors: Plottier
authors: Neonatal Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors: Kevin I
authors: KI
authors: Wheeler
authors: Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.|School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors: Sanoj K M
authors: SK
authors: Ali
authors: School of Engineering and ICT, University of Tasmania, Hobart, Tasmania, Australia.
authors: Omid Sadeghi
authors: OS
authors: Fathabadi
authors: School of Engineering and ICT, University of Tasmania, Hobart, Tasmania, Australia.
authors: Rohan
authors: R
authors: Jayakar
authors: School of Engineering and ICT, University of Tasmania, Hobart, Tasmania, Australia.
authors: Timothy J
authors: TJ
authors: Gale
authors: Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.|Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
authors: Peter A
authors: PA
authors: Dargaville
mesh_terms: D000465:Algorithms; D001331:Automation; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D008297:Male; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Intensive Care; Neonatology; Respiratory