Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

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

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)657-63
Number of pages7
JournalPediatric Research
Volume78
Issue number6
DOIs
Publication statusPublished - Dec 2015

Keywords

  • Animals
  • Animals, Newborn
  • Automation
  • Biological Products
  • Disease Models, Animal
  • Feasibility Studies
  • Female
  • Gestational Age
  • Hyperoxia
  • Intubation, Intratracheal
  • Lung
  • Male
  • Oxygen Inhalation Therapy
  • Phospholipids
  • Pregnancy
  • Premature Birth
  • Pulmonary Surfactants
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Newborn
  • Resuscitation
  • Sheep
  • Time Factors

Cite this

Hütten, Matthias C. ; Goos, Tom G ; Ophelders, Daan ; Nikiforou, Maria ; Kuypers, Elke ; Willems, Monique ; Niemarkt, Hendrik J ; Dankelman, Jenny ; Andriessen, Peter ; Mohns, Thilo ; Reiss, Irwin K M ; Kramer, Boris W. / Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs. In: Pediatric Research. 2015 ; Vol. 78, No. 6. pp. 657-63.
@article{a5900b7abd944fe1a3985491a2e1cb89,
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.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.",
keywords = "Animals, Animals, Newborn, Automation, Biological Products, Disease Models, Animal, Feasibility Studies, Female, Gestational Age, Hyperoxia, Intubation, Intratracheal, Lung, Male, Oxygen Inhalation Therapy, Phospholipids, Pregnancy, Premature Birth, Pulmonary Surfactants, Respiration, Artificial, Respiratory Distress Syndrome, Newborn, Resuscitation, Sheep, Time Factors",
author = "H{\"u}tten, {Matthias C.} and Goos, {Tom G} and Daan Ophelders and Maria Nikiforou and Elke Kuypers and Monique Willems and Niemarkt, {Hendrik J} and Jenny Dankelman and Peter Andriessen and Thilo Mohns and Reiss, {Irwin K M} and Kramer, {Boris W}",
year = "2015",
month = "12",
doi = "10.1038/pr.2015.158",
language = "English",
volume = "78",
pages = "657--63",
journal = "Pediatric Research",
issn = "0031-3998",
publisher = "Nature Publishing Group",
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}

Hütten, MC, Goos, TG, Ophelders, D, Nikiforou, M, Kuypers, E, Willems, M, Niemarkt, HJ, Dankelman, J, Andriessen, P, Mohns, T, Reiss, IKM & Kramer, BW 2015, 'Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs', Pediatric Research, vol. 78, no. 6, pp. 657-63. https://doi.org/10.1038/pr.2015.158

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs. / Hütten, Matthias C.; Goos, Tom G; Ophelders, Daan; Nikiforou, Maria; Kuypers, Elke; Willems, Monique; Niemarkt, Hendrik J; Dankelman, Jenny; Andriessen, Peter; Mohns, Thilo; Reiss, Irwin K M; Kramer, Boris W.

In: Pediatric Research, Vol. 78, No. 6, 12.2015, p. 657-63.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

AU - Hütten, Matthias C.

AU - Goos, Tom G

AU - Ophelders, Daan

AU - Nikiforou, Maria

AU - Kuypers, Elke

AU - Willems, Monique

AU - Niemarkt, Hendrik J

AU - Dankelman, Jenny

AU - Andriessen, Peter

AU - Mohns, Thilo

AU - Reiss, Irwin K M

AU - Kramer, Boris W

PY - 2015/12

Y1 - 2015/12

N2 - 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.

AB - 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.

KW - Animals

KW - Animals, Newborn

KW - Automation

KW - Biological Products

KW - Disease Models, Animal

KW - Feasibility Studies

KW - Female

KW - Gestational Age

KW - Hyperoxia

KW - Intubation, Intratracheal

KW - Lung

KW - Male

KW - Oxygen Inhalation Therapy

KW - Phospholipids

KW - Pregnancy

KW - Premature Birth

KW - Pulmonary Surfactants

KW - Respiration, Artificial

KW - Respiratory Distress Syndrome, Newborn

KW - Resuscitation

KW - Sheep

KW - Time Factors

U2 - 10.1038/pr.2015.158

DO - 10.1038/pr.2015.158

M3 - Article

C2 - 26322409

VL - 78

SP - 657

EP - 663

JO - Pediatric Research

JF - Pediatric Research

SN - 0031-3998

IS - 6

ER -