38 Chapter 2 Clinical effect Reynolds et al. reported an increase of 31% more time within TR (80% during automated, 49% during manual; P < 0.0001) in 30 preterm infants (Table 1). This was accompanied by less time in hypoxia and hyperoxia, albeit with more hyperoxic episodes in the automated arm. These so-called overshoot episodes are common39, and perhaps impossible to prevent. Predictive Intelligent Control of Oxygenation19 How it works PRICO (Predictive Intelligent Control of Oxygenation) is a rule-based algorithm originally designed for the delivery room. It is now available for NICU use in the Fabian ventilator (Acutronic, Hirzel, Switzerland). The algorithm uses the current SpO2, its trend, and a prediction of what SpO2 will become to make step-wise adjustments. Comparable to CLAC, each adjustment is followed by a pause of at least 30 seconds. The set FiO2 is limited to an adjustment range which is specified by the caregiver. If the limits of this range are met, PRICO will alarm and pause until the issue is resolved. Information on how exactly the algorithm operates is limited. Whilst in TR stepwise adjustments are limited to ±1%, whereas outside the TR adjustments vary from ±1-10%. Large, swift changes are recognised using the SpO2 trend and are used to fine tune the magnitude of the FiO2 adjustments. A prediction based on this trend is used to limit possible under/overshoots. Before an adjustment safety checks are performed (reliability of the connection, assessment of the correctness of parameters).19, 40 There is currently not enough data available to give a complete appraisal of this algorithm. Clinical effect So far, for PRICO there is no clinical data available to date, feasibility has only been tested on preterm lambs while using volume guarantee ventilation.19 The time spent within target range was significantly higher with AOC (93.2% vs 84.0%, P < 0.05). A 30 second lockout could potentially delay appropriate intervention against hypoxia and hyperoxia. SPO2C34 How it works The SPO2C algorithmwas developed in Ulm, Germany and is commercially available
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