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.

CONCLUSION:

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: Matthias C Hütten, Tom G Goos, Daan Ophelders, Maria Nikiforou, Elke Kuypers, Monique Willems, Hendrik J Niemarkt, Jenny Dankelman, Peter Andriessen, Thilo Mohns, Irwin K M Reiss, Boris W Kramer
• Journal: Pediatric research (Pediatr Res) Vol. 78 Issue 6 Pg. 657-63 (Dec 2015) ISSN: 1530-0447 [Electronic] United States
• PMID: 26322409 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biological Products
• Phospholipids
• Pulmonary Surfactants
• poractant alfa

Topics

• Animals
• Animals, Newborn
• Automation
• Biological Products (pharmacology)
• Disease Models, Animal
• Feasibility Studies
• Female
• Gestational Age
• Hyperoxia (etiology, physiopathology, prevention & control)
• Intubation, Intratracheal
• Lung (drug effects, embryology, physiopathology)
• Male
• Oxygen Inhalation Therapy (adverse effects, methods)
• Phospholipids (pharmacology)
• Pregnancy
• Premature Birth
• Pulmonary Surfactants (pharmacology)
• Respiration, Artificial (adverse effects, methods)
• Respiratory Distress Syndrome, Newborn (physiopathology, therapy)
• Resuscitation (adverse effects, methods)
• Sheep
• Time Factors