University of Tasmania

File(s) under permanent embargo

Automated control of oxygen titration in preterm infants on non-invasive respiratory support

journal contribution
posted on 2023-05-21, 02:54 authored by Peter DargavillePeter Dargaville, Andrew MarshallAndrew Marshall, Oliver Ladlow, Bannink, C, Jayakar, R, Caillin Eastwood-SutherlandCaillin Eastwood-Sutherland, Kai LimKai Lim, Ali, SKM, Timothy GaleTimothy Gale

Objective: To evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency.

Design: Interventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each).

Setting: Neonatal intensive care unit.

Participants: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26-28) and postnatal age 17 (12-23) days.

Intervention: Automated oxygen titration with the VDL1.1 algorithm, with the incoming SpO2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO2) adjustments actuated by a motorised blender. The desired SpO2 range was 90%-94%, with bedside clinicians able to make corrective manual FiO2 adjustments at all times.

Main outcome measures: Target range (TR) time (SpO2 90%-94% or 90%-100% if in air), periods of SpO2 deviation, number of manual FiO2 adjustments and oxygen requirement were compared between automated and manual control periods.

Results: In 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51-64)% vs automated 81 (72-85)%, p<0.001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25-32)% and automated 26 (24-32)%, p=0.13).

Conclusion: The VDL1.1 algorithm was safe and effective in SpO2 targeting in preterm infants on non-invasive respiratory support. Trial registration number: ACTRN12616000300471.


Publication title

Archives of Disease in Childhood






Menzies Institute for Medical Research


British Medical Association

Place of publication

United Kingdom

Rights statement

© Author(s) (or their employer(s)) 2021

Repository Status

  • Restricted

Socio-economic Objectives

Treatment of human diseases and conditions

Usage metrics

    University Of Tasmania



    Ref. manager