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  • 1
    Online Resource
    Online Resource
    31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016): part two : National Harbor, MD, USA. 9-13 November 2016
    BMJ ; 2016
    In:  Journal for ImmunoTherapy of Cancer Vol. 4, No. S1 ( 2016-11)
    Details
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 4, No. S1 ( 2016-11)
    Type of Medium: Online Resource
    ISSN: 2051-1426
    URL: Article
    DOI: 10.1186/s40425-016-0173-6
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 2719863-7
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  • 2
    Online Resource
    Online Resource
    Apnoea-triggered increase in fraction of inspired oxygen in preterm infants: a randomised cross-over study
    BMJ ; 2023
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ
    Abstract: To investigate the impact of a pre-emptive apnoea triggered oxygen response on oxygen saturation (SpO 2 ) targeting following central apnoea in preterm infants. Design Interventional crossover study of a 12-hour period of automated oxygen control with an apnoea response (AR) module, nested within a crossover study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking 12-hour periods of manual control. Setting Neonatal intensive care unit Patients Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median (IQR) birth gestation 27 (26–28) weeks, postnatal age 17 (12–23) days. Intervention Automated oxygen titration with an automated control algorithm modified to include an AR module. Alterations to inspired oxygen concentration (FiO 2 ) were actuated by a motorised blender. Desired SpO 2 range was 90–94%. Apnoea detection was by capsule pneumography. Main outcome measures Duration, magnitude and area under the curve (AUC) of SpO 2 deviations following apnoea; frequency and duration of apnoeic events. Comparisons between periods of manual, automated and automated control with AR module. Results In 60 studies in 35 infants, inclusion of the AR module significantly reduced AUC for SpO 2 deviations below baseline compared with both automated and manual control (manual: 87.1%±107.6% s, automated: 84.6%±102.8% s, AR module: 79.4%±102.7% s). However, there was a coincident increase in SpO 2 overshoot (AUC (SpO 2 〉 SpO 2(onset) ); manual: 44.3±99.9% s, automated: 54.7%±103.4% s, AR module: 65.7%±126.2% s). Conclusion Automated control with a pre-emptive apnoea-triggered FiO 2 boost resulted in a modest reduction in post-apnoea hypoxaemia, but was followed by a greater SpO 2 overshoot. Trial registration number ACTRN12616000300471.
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2023-325849
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2188490-0
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  • 3
    Online Resource
    Online Resource
    Automated control of oxygen titration in preterm infants on non-invasive respiratory support
    BMJ ; 2022
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition Vol. 107, No. 1 ( 2022-01), p. 39-44
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 107, No. 1 ( 2022-01), p. 39-44
    Abstract: 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 SpO 2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO 2 ) adjustments actuated by a motorised blender. The desired SpO 2 range was 90%–94%, with bedside clinicians able to make corrective manual FiO 2 adjustments at all times. Main outcome measures Target range (TR) time (SpO 2 90%–94% or 90%–100% if in air), periods of SpO 2 deviation, number of manual FiO 2 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 FiO 2 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 SpO 2 targeting in preterm infants on non-invasive respiratory support. Trial registration number ACTRN12616000300471.
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2020-321538
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2188490-0
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  • 4
    Online Resource
    Online Resource
    Mask versus nasal prong leak and intermittent hypoxia during continuous positive airway pressure in very preterm infants
    BMJ ; 2021
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition Vol. 106, No. 1 ( 2021-01), p. 81-83
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 106, No. 1 ( 2021-01), p. 81-83
    Abstract: Nasal continuous positive airway pressure (NCPAP) can be applied via binasal prongs or nasal masks; both may be associated with air leak and intermittent hypoxia. We investigated whether the latter is more frequent with nasal masks or prongs. Methods Continuous 24 hours recordings of inspired oxygen fraction (FiO 2 ), pulse rate, respiratory rate, pulse oximeter saturation (SpO 2 ) and CPAP level were made in preterm infants with respiratory insufficiency (n=20) managed on CPAP in the NICU at the Royal Hobart Hospital. As part of routine care, nasal interfaces were alternated 4-hourly between mask and prongs. In each recording, the first two segments containing at least 3 hours of artefact-free signal for each interface were selected. Recordings were analysed for episodes with hypoxaemia (SpO 2 〈 80% for ≥10 s) and bradycardia (pulse rate 〈 80/min for ≥4 s) and for episodes of pressure loss at the nasal interface. Data were compared using Wilcoxon-matched pairs test and are reported as median (IQR). Results Infants had a gestational age at birth of 26 (25-27) weeks and postnatal age of 17 (14–24) days. There was no difference in %time with interface leak between prong and mask (0.9 (0–8)% vs 1.1 (0–18)%, p=0.82), %time with SpO 2 〈 80% (0.15 (0–1.2)% vs 0.06 (0–0.8)%, p=0.74) or heart rate 〈 80/min (0.03 (0–0.2)% vs 0 (0–0.2)%, p=0.64). Three infants had interface leak for 〉 10% of the time with prongs and 5 with the mask. Conclusion Both interfaces resulted in a similarly stable provision of positive airway pressure, and there was also no difference in the occurrence of intermittent hypoxia.
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2020-319092
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2188490-0
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