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

Hyperoxia and hypoxia influence morbidity and mortality of preterm infants. Automated closed-loop control of the fraction of inspired oxygen (FiO₂) 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 FiO₂ control based on predefined oxygen saturation (SpO₂) 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 FiO₂ control, targeting SpO₂ according to the Dawson curve in the first 10 min and SpO₂ 90-95% hereafter. Automated FiO₂ control also was applied during surfactant replacement therapy and subsequent ventilation.Results:Time within target range did not differ significantly between manual and automated FiO₂ control during resuscitation, however automated FiO₂ control significantly avoided hyperoxia. Automated FiO₂ control was feasible during surfactant replacement and kept SpO₂ within target range significantly better than manual control during subsequent ventilation.Conclusion:In our model, fully automated FiO₂ control was feasible in rapidly changing physiologic conditions during postnatal resuscitation and prevented hyperoxia. We conclude that closed loop FiO₂ control is a promising tool for the delivery room.