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Automated control of oxygen titration in preterm infants on non-invasive respiratory support

Dargaville, PA, Marshall, AP, Ladlow, OJ, Bannink, C, Jayakar, R, Eastwood-Sutherland, C ORCID: 0000-0002-5261-0287, Lim, K, Ali, SKM and Gale, TJ ORCID: 0000-0003-0524-2642 2021 , 'Automated control of oxygen titration in preterm infants on non-invasive respiratory support' , Archives of Disease in Childhood , F1-F6 , doi: 10.1136/archdischild-2020-321538.

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Objective: To evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency. Design: Interventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each). Setting: Neonatal intensive care unit. Participants: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26-28) and postnatal age 17 (12-23) days. Intervention: Automated oxygen titration with the VDL1.1 algorithm, with the incoming SpO2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO2) adjustments actuated by a motorised blender. The desired SpO2 range was 90%-94%, with bedside clinicians able to make corrective manual FiO2 adjustments at all times. Main outcome measures: Target range (TR) time (SpO2 90%-94% or 90%-100% if in air), periods of SpO2 deviation, number of manual FiO2 adjustments and oxygen requirement were compared between automated and manual control periods. Results: In 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51-64)% vs automated 81 (72-85)%, p2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25-32)% and automated 26 (24-32)%, p=0.13). Conclusion: The VDL1.1 algorithm was safe and effective in SpO2 targeting in preterm infants on non-invasive respiratory support. Trial registration number: ACTRN12616000300471.

Item Type: Article
Authors/Creators:Dargaville, PA and Marshall, AP and Ladlow, OJ and Bannink, C and Jayakar, R and Eastwood-Sutherland, C and Lim, K and Ali, SKM and Gale, TJ
Keywords: neonatology, physiology, technology
Journal or Publication Title: Archives of Disease in Childhood
Publisher: British Medical Association
ISSN: 1359-2998
DOI / ID Number: 10.1136/archdischild-2020-321538
Copyright Information:

© Author(s) (or their employer(s)) 2021

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