Plottier Gemma K, Wheeler Kevin I, Ali Sanoj K M, Fathabadi Omid Sadeghi, Jayakar Rohan, Gale Timothy J, Dargaville Peter A
Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.
School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Arch Dis Child Fetal Neonatal Ed. 2017 Jan;102(1):F37-F43. doi: 10.1136/archdischild-2016-310647. Epub 2016 Aug 29.
To evaluate the performance of a novel rapidly responsive proportional-integral-derivative (PID) algorithm for automated oxygen control in preterm infants with respiratory insufficiency.
Interventional study of a 4-hour period of automated oxygen control compared with combined data from two flanking periods of manual control (4 hours each).
Neonatal intensive care unit.
Preterm infants (n=20) on non-invasive respiratory support and supplemental oxygen, with oxygen saturation (SpO) target range 90%-94% (manual control) and 91%-95% (automated control). Median gestation at birth 27.5 weeks (IQR 26-30 weeks), postnatal age 8.0 (1.8-34) days.
Automated oxygen control using a standalone device, receiving SpO input from a standard oximeter and computing alterations to oxygen concentration that were actuated with a modified blender. The PID algorithm was enhanced to avoid iatrogenic hyperoxaemia and adapt to the severity of lung dysfunction.
Proportion of time in the SpO target range, or above target range when in air.
Automated oxygen control resulted in more time in the target range or above in air (manual 56 (48-63)% vs automated 81 (76-90)%, p<0.001) and less time at both extremes of oxygenation. Prolonged episodes of hypoxaemia and hyperoxaemia were virtually eliminated. The control algorithm showed benefit in every infant. Manual changes to oxygen therapy were infrequent during automated control (0.24/hour vs 2.3/hour during manual control), and oxygen requirements were unchanged (automated control period 27%, manual 27% and 26%, p>0.05).
The novel PID algorithm was very effective for automated oxygen control in preterm infants, and deserves further investigation.
评估一种新型快速响应比例积分微分（PID）算法在呼吸功能不全早产儿自动氧疗中的性能。
对4小时自动氧疗期进行干预性研究，并与两个相邻手动控制期（各4小时）的合并数据进行比较。
新生儿重症监护病房。
接受无创呼吸支持和补充氧气的早产儿（n = 20），氧饱和度（SpO）目标范围为90%-94%（手动控制）和91%-95%（自动控制）。出生时胎龄中位数为27.5周（四分位间距26-30周），出生后年龄为8.0（1.8-34）天。
使用独立设备进行自动氧疗，该设备从标准血氧仪接收SpO输入，并计算氧浓度变化，通过改良混合器进行调节。PID算法得到改进，以避免医源性高氧血症，并适应肺功能障碍的严重程度。
处于SpO目标范围内或在空气中高于目标范围的时间比例。
自动氧疗使处于目标范围内或在空气中高于目标范围的时间更多（手动控制为56（48-63）%，自动控制为81（76-90）%，p<0.001），且在氧合的两个极端情况的时间更少。长时间的低氧血症和高氧血症几乎消除。控制算法对每个婴儿都有好处。自动控制期间很少进行手动氧疗调整（0.24次/小时，而手动控制期间为2.3次/小时），且氧需求未变（自动控制期为27%，手动控制期分别为27%和26%，p>0.05）。
新型PID算法在早产儿自动氧疗中非常有效，值得进一步研究。
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