Development and preclinical testing of an adaptive algorithm for automated control of inspired oxygen in the preterm infant

Objective To assess the performance of a novel algorithm for automated oxygen control using a simulation of oxygenation founded on in vivo data from preterm infants. Methods A proportional integral derivative (PID) control algorithm was enhanced by (i) compensation for the non-linear SpO(2)-PaO2 relationship, (ii) adaptation to the severity of lung dysfunction and (iii) error attenuation within the target range. Algorithm function with and without enhancements was evaluated by iterative linking with a computerised simulation of oxygenation. Data for this simulation (FiO(2) and SpO(2) at 1 Hz) were sourced from extant recordings from preterm infants (n=16), and converted to a datastream of values for ventilation: perfusion ratio and shunt. Combination of this datastream second by second with the FiO(2) values from the algorithm under test produced a sequence of novel SpO(2) values, allowing time in the SpO(2) target range (91%-95%) and in various degrees of hypoxaemia and hyperoxaemia to be determined. A PID algorithm with 30 s lockout after each FiO(2) adjustment, and a proportional derivative (PD) algorithm were also evaluated. Results Separate addition of each enhancing feature to the PID algorithm showed a benefit, but not with uniformly positive effects. The fully enhanced algorithm was optimal for the combination of targeting the desired SpO(2) range and avoiding time in, and episodes of, hypoxaemia and hyperoxaemia. This algorithm performed better than one with a 30 s lockout, and considerably better than PD control. Conclusions An enhanced PID algorithm was very effective for automated oxygen control in a simulation of oxygenation, and deserves clinical evaluation.