Neonatal automated oxygen titration algorithms: response characteristics and performance
Year: 2026
Type: article
Abstract: Objective Neonatal respiratory support devices now have algorithms for automated adjustment of oxygen concentration (fraction of inspired oxygen (FiO 2 )) in response to oxygen saturation (SpO 2 ) disturbances, but their performance has not been systematically examined. We investigated the response of six available devices and algorithms to standardised and simulated SpO 2 disturbances. Design Bench-top study in neonatal centres. Methods Devices under study received SpO 2 input from a vital signs simulator at 1 Hz; device response was recorded as measured FiO 2 in the respiratory circuit. Response to protracted hypoxaemia (SpO 2 =80%) and hyperoxaemia (SpO 2 =98%) was examined in several test conditions. In closed-loop testing, measured FiO 2 was combined with abstracted patient data in an oxygenation simulator, generating novel SpO 2 values input to the device. Device capability in keeping simulated SpO 2 in target range (91–95%) was examined, as was FiO 2 adjustment frequency and propensity for FiO 2 oscillation. Results The FiO 2 trajectories in response to SpO 2 disturbances differed considerably between devices. Maximum rate of sustained FiO 2 escalation (ΔFiO 2 /min) during hypoxaemia was Avea: 0.30; Fabian: 0.20; Leoni: 0.20; SLE: 0.10; Sophie: 0.062; Vapotherm: 0.30. Corresponding values for FiO 2 reduction during hyperoxaemia were 1.20, 0.20, 0.20, 0.13, 0.53 and 1.32. In closed-loop testing, average SpO 2 target range time proportion was 51%, 52%, 55%, 77%, 64% and 53% for the six devices, respectively, with 1.9–5.1 automated FiO 2 adjustments/min, in some cases with a prominent oscillatory pattern. Conclusions Automated oxygen control devices exhibit considerable variation in their FiO 2 response to SpO 2 disturbances, with important consequences for SpO 2 targeting potential and the pattern of FiO 2 adjustment.
Institutions: University of Tasmania, Leiden University Medical Center, Willem-Alexander Kinderziekenhuis, Menzies Institute for Medical Research, Heidelberg University, University Hospital Heidelberg, Universitätsklinikum Tübingen, University of Miami, Erasmus MC, Erasmus MC - Sophia Children’s Hospital, Delft University of Technology, Universität Ulm, University of Bristol, University of Oxford, Poznan University of Medical Sciences, Royal Hobart Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7214097648