Automated closed-loop<i>versus</i>standard manual oxygen administration after major abdominal or thoracic surgery: an international multicentre randomised controlled study

L’Her, Erwan; Jaber, Samir; Verzilli, Daniel; Jacob, Christophe; Huiban, Brigitte; Futier, Emmanuel; Kerforne, Thomas; Pateau, Victoire; Bouchard, Pierre-Alexandre; Consigny, Maëlys; Lellouche, François

doi:10.1183/13993003.00182-2020

Cited by 19 publications

(29 citation statements)

References 60 publications

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“…Recent studies found closed-loop oxygen delivery system with automated oxygen titration to be associated with more time spent within the SpO 2 target range in patient admitted to an emergency department [ 13 ], in patients with chronic respiratory disease with exercise-induced desaturation [ 14 ], in surgical patients after extubation [ 15 ], and in patients weaning from invasive ventilation [ 16 ]. Thus far, only one study has been performed in patients with mild AHRF treated with HFNO [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

et al. 2022

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Background We aimed to assess the efficacy of a closed-loop oxygen control in critically ill patients with moderate to severe acute hypoxemic respiratory failure (AHRF) treated with high flow nasal oxygen (HFNO). Methods In this single-centre, single-blinded, randomized crossover study, adult patients with moderate to severe AHRF who were treated with HFNO (flow rate ≥ 40 L/min with FiO2 ≥ 0.30) were randomly assigned to start with a 4-h period of closed-loop oxygen control or 4-h period of manual oxygen titration, after which each patient was switched to the alternate therapy. The primary outcome was the percentage of time spent in the individualized optimal SpO2 range. Results Forty-five patients were included. Patients spent more time in the optimal SpO2 range with closed-loop oxygen control compared with manual titrations of oxygen (96.5 [93.5 to 98.9] % vs. 89 [77.4 to 95.9] %; p < 0.0001) (difference estimate, 10.4 (95% confidence interval 5.2 to 17.2). Patients spent less time in the suboptimal range during closed-loop oxygen control, both above and below the cut-offs of the optimal SpO2 range, and less time above the suboptimal range. Fewer number of manual adjustments per hour were needed with closed-loop oxygen control. The number of events of SpO2 < 88% and < 85% were not significantly different between groups. Conclusions Closed-loop oxygen control improves oxygen administration in patients with moderate-to-severe AHRF treated with HFNO, increasing the percentage of time in the optimal oxygenation range and decreasing the workload of healthcare personnel. These results are especially relevant in a context of limited oxygen supply and high medical demand, such as the COVID-19 pandemic. Trial registration The HILOOP study was registered at www.clinicaltrials.gov under the identifier NCT04965844.

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Section: Introductionmentioning

confidence: 99%

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

et al. 2022

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“…More recently, oxygen delivery systems have been developed which are able to automatically titrate the delivered oxygen concentration in order to achieve a target SpO 2 , based on continuous feedback from an associated sensor [ 18 ]. This method of automatic oxygen titration results in an increased proportion of time spent with SpO 2 in target range compared to manual oxygen titration in a ward setting [ 19 ], the emergency department [ 20 ] and following major surgery [ 21 ]. However, it remains to be elucidated whether the use of such systems translates into improved clinical outcomes and what role they may play in routine clinical care.…”

Section: Discussionmentioning

confidence: 99%

Determination of oxygen saturation compared to a prescribed target range using continuous pulse oximetry in acutely unwell medical patients

et al. 2021

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Background Both inadequate and excessive administration of oxygen to acutely unwell patients results in risk of harm. Guidelines recommend titration of oxygen to achieve a target oxygen saturation (SpO2) range. Information regarding whether this is being achieved is limited. Methods In this two-centre non-interventional study we used continuous pulse oximetry in acutely unwell medical patients over a 24-h period to determine the proportion of time spent with SpO2 within the prescribed target range and whether this is influenced by the target range, age, care in a high-dependency area and the number of oxygen adjustments. Results Eighty participants were included in the analysis. The mean (SD) proportion of time spent in target range was 55.6% (23.6), this was lower in those with a reduced hypercapnic target range (88–92% or below) compared to those with a range of 92–96%; difference − 13.1% (95% CI − 3.0 to − 23.2), P = 0.012. The proportion of time spent above range was 16.2% (22.9); this was higher in those with a reduced hypercapnic range; difference 21.6% (31.4 to 12), P < 0.001. The proportion of time below range was 28.4% (25.2); there was no difference between target ranges. The proportion of time spent in range was higher for those in a high dependency area in the multivariate model; difference 15.5% (95% CI 2.3 to 28.7), P = 0.02. Conclusions Medical patients receiving oxygen in a ward setting spend significant periods of time with SpO2 both above and below the prescribed target range while receiving oxygen therapy.

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“… 33 , 34 , 35 Oxygen can be titrated using a closed‐loop control system in which there is automated adjustment of the delivered oxygen concentration in response to continuous measurement of SpO 2 . This results in a greater proportion of time within a prescribed target SpO 2 range compared to manual oxygen titration, in non‐ventilated adult patients with acute illnesses using standard nasal cannulae, face mask 36 , 37 , 38 or hNHF‐O 2 39 , 40 (Grade B). Practice points : In the presence of COPD or conditions associated with chronic respiratory failure: If SpO 2 ≥ 88%, oxygen therapy is not initially required.…”

Section: B Recommendations In Detailmentioning

confidence: 99%

Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: ‘Swimming between the flags’

Barnett¹,

Beasley

Buchan

et al. 2022

Respirology

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Oxygen is a life-saving therapy but, when given inappropriately, may also be hazardous. Therefore, in the acute medical setting, oxygen should only be given as treatment for hypoxaemia and requires appropriate prescription, monitoring and review. This update to the Thoracic Society of Australia and New Zealand (TSANZ) guidance on acute oxygen therapy is a brief and practical resource for all healthcare workers involved with administering oxygen therapy to adults in the acute medical setting. It does not apply to intubated or paediatric patients. Recommendations are made in the following six clinical areas: assessment of hypoxaemia (including use of arterial blood gases); prescription of oxygen; peripheral oxygen saturation targets; delivery, including non-invasive ventilation and humidified high-flow nasal cannulae; the significance of high oxygen requirements; and acute hypercapnic respiratory failure. There are three sections which provide (1) a brief summary, (2) recommendations in detail with practice points and (3) a detailed explanation of the reasoning and evidence behind the recommendations. It is anticipated that these recommendations will be disseminated widely in structured programmes across Australia and New Zealand. K E Y W O R D S acute oxygen therapy, oxygen prescription, position statement, target oxygen saturations, titrated oxygen This document has been endorsed by the Thoracic Society of Australia and New Zealand Board on 18 February 2022. It is due for review in 2027. The authors are listed in alphabetical order.

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Automated closed-loopversusstandard manual oxygen administration after major abdominal or thoracic surgery: an international multicentre randomised controlled study

Cited by 19 publications

References 60 publications

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study)

Determination of oxygen saturation compared to a prescribed target range using continuous pulse oximetry in acutely unwell medical patients

Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: ‘Swimming between the flags’

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