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Related Experiment Video

Updated: Jan 19, 2026

Open and closed-loop control systems
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Is faster better? A randomised crossover study comparing algorithms for closed-loop automatic oxygen control.

Christoph E Schwarz1, André Kidszun2, Nicole S Bieder3

  • 1Department of Neonatology, University Children's Hospital, Tuebingen, Germany C.Schwarz@med.uni-tuebingen.de.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|September 19, 2019
PubMed
Summary

A new faster closed-loop automatic control (CLAC) algorithm for oxygen delivery improved oxygen saturation in preterm infants. This advanced CLAC system was superior to routine care and not inferior to a slower CLAC method.

Keywords:
NeonatologyRespiratorycontrollerhypoxiaventilation

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Area of Science:

  • Neonatal Medicine
  • Respiratory Care
  • Biomedical Engineering

Background:

  • Closed-loop automatic control (CLAC) of fractional inspired oxygen (FiO2) has shown promise in improving oxygen administration for preterm infants.
  • Evaluating newer, potentially more efficient CLAC algorithms is crucial for optimizing respiratory support in vulnerable neonates.

Purpose of the Study:

  • To compare a revised, faster CLAC algorithm (CLACfast) against routine manual control (RMConly) and a slower CLAC algorithm (CLACslow).
  • To determine if CLACfast increases the proportion of time within target oxygen saturation ranges in preterm infants.
  • To assess the non-inferiority of CLACfast compared to CLACslow.

Main Methods:

  • An unblinded, randomized controlled crossover study was conducted in two German tertiary neonatal intensive care units.
  • Infants (n=19, gestational age 27±2 weeks) on respiratory support received FiO2 control via RMConly, CLACfast, or CLACslow for 8-hour periods each, in random order.
  • The primary outcome measure was the percentage of time with arterial hemoglobin oxygen saturation within target ranges (Target%).

Main Results:

  • CLACfast achieved a mean Target% of 68%±11%, significantly higher than RMConly (58%±11%).
  • CLACfast demonstrated non-inferiority to CLACslow (65%±11%), with one-sided p-values <0.001 for both superiority over RMConly and non-inferiority to CLACslow.
  • The study included 19 infants receiving non-invasive (n=18) or invasive (n=1) respiratory support.

Conclusions:

  • The revised, faster CLAC algorithm (CLACfast) is superior to routine manual oxygen control in preterm infants requiring respiratory support.
  • CLACfast is not inferior to a previously validated slower CLAC algorithm, suggesting its efficacy and potential for improved oxygen management.
  • This faster CLAC approach offers a promising advancement in automated respiratory care for neonates.