Preliminary study of automated oxygen titration at birth for preterm infants

Abstract

ObjectiveTo study the feasibility of automated titration of oxygen therapy in the delivery room for preterm infants.DesignProspective 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.SettingDelivery rooms of a tertiary level hospital.ParticipantsPreterm infants <32 weeks gestation (n=20 per group).InterventionAutomated 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 measuresProportion 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.ResultsTime 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.ConclusionAutomated oxygen titration using a purpose-built algorithm is feasible for delivery room management of preterm infants, and warrants further evaluation.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

“…Reliability of servo-controlled algorithms for keeping oxygen saturations within defined ranges has been tested in the delivery room [101] as well as in MV [102] and NIV neonates [103]. Automated oxygen control significantly increases the time within the intended range, thus potentially reducing nursing workload.…”

Fluctuations in Oxygen Saturation during Synchronized Nasal Intermittent Positive Pressure Ventilation and Nasal High-Frequency Oscillatory Ventilation in Very Low Birth Weight Infants: A Randomized Crossover Trial

“…But due to the strict inclusion criteria, pre-study respiratory parameters displayed a high inter-patient degree of correspondence within a patient population of very immature and respiratory unstable infants who have the highest risks for long-term morbidities. In line, the time spent within the SpO 2 target during sNIPPV with 59.9% was lower than in the majority of studies on this topic but within the expected range of comparable cohorts [23,24]. This might have been overlooked in a more stable study population with less severe respiratory course.…”

Review of guidelines on the management of respiratory distress syndrome

“…Надежность алгоритмов современных аппаратов ИВЛ с сервоуправлением для поддержания SpO 2 пациента в заданных диапазонах была проверена в родильном зале [60], а также у новорожденных, находящихся на традиционной [61] и неинвазивной ИВЛ [62]. Автоматизированный контроль кислорода значительно увеличивает время нахождения SpO 2 в заданном целевом диапазоне, потенциально снижая нагрузку на медицинский персонал, тогда как долгосрочные клинические преимущества пока не определены.…”