Hylke Salverda

173 10 Summary Currently available automated oxygen control algorithms In chapter 2, we described the six automated oxygen control systems which are currently commercially available for use in the NICU. All systems are discussed in light of their algorithm, strategy and, if known, effect. Our goal was to provide guidance to clinicians seeking to comprehend AOC and those possibly seeking to implement this technology in their practice. We explained the basic approaches applied, namely rule-based, proportional-integral-derivative and the adaptive approach. Also, we gave an overview of how each of the six algorithms work and, where available, we gave an overview of clinical effect. When compared to manual titration, all these commercially available algorithms have shown a beneficial effect on the proportion of time that oxygen saturation of preterm infants is within the set target range, and they all demonstrate a decrease in hyperoxia and severe hypoxia. AOC may also reduce the workload for bedside staff. Although not reported to date, there is a concern that these devices may mask clinical deterioration. So far, trials involving different algorithms were heterogeneous in design and no head-to-head comparisons have been made, making it difficult to differentiate which algorithm is most effective and what clinicians can expect from algorithms under certain conditions. Effectivity of automated oxygen control algorithms on oxygenation of preterm infants in the NICU In chapter 3, we compared the effect of two different automated oxygen control devices on target range time and occurrence of hypoxic and hyperoxic episodes in a randomised cross-over trial in the Leiden University Medical Center. We included fifteen preterm infants born between 24 weeks and 29 weeks and 6 days of gestation, receiving invasive or non-invasive respiratory support. Inspired oxygen concentration was titrated by theOxyGenie controller (SLE6000 ventilator) and the CLiO2 controller (AVEA ventilator) for 24 hours each in a random sequence with the respiratory support mode kept constant. The main outcome was time spent within the set oxygen saturation target range (TR; 91%-95% with supplemental oxygen, 91%-100% without supplemental oxygen). The infants in the study had a median gestational age of 26 weeks and 4 days (interquartile range (IQR) 25 weeks 3 days - 27 weeks 6 days) and a post-natal age of 19 (IQR 17-24) days. Time spent within the TR was higher during OxyGenie control (80.2 (IQR 72.6–82.4) % vs 68.5 (IQR 56.7–79.3) %, p<0.005). Less time was spent above TR while receiving supplemental oxygen (6.3 (IQR 5.1-9.9) % vs 15.9 (IQR 11.5-30.7) %, p<0.005) but more time was spent below TR during OxyGenie control (14.7 (IQR 11.8-17.2) % vs 9.3 (IQR 8.2-12.6)