Automated Oxygen Delivery in Hospitalized Patients with Acute Respiratory Failure: A Pilot Study

Abstract

Background and Objectives. Despite its’ proven benefits, oxygen therapy may be complicated with potential adverse events such as hypoxemia or hyperoxia-driven hypercapnia. Automated oxygen delivery systems may aid in avoiding these complications. The scope of the present study is to test the efficacy and safety of a new automated oxygen delivery device. Methods. This study included 23 patients with acute respiratory failure (ARF) hospitalized in the Respiratory Medicine Department of the University Hospital of Larissa. Both patients with purely hypoxemic or hypercapnic ARF were included. Automated oxygen administration was performed with Digital Oxygen Therapy, a new closed-loop system designed to automatically adjust oxygen flow according to target oxygen saturation (SpO2) of 88–92% for hypercapnic patients and 92–96% for purely hypoxemic patients with ARF. The device was applied for 4 hours. Arterial blood gas analysis was performed at 1 hour and 3 hours following the device application. Results. Mean age was 72.91 ± 13.91 years. Twelve patients were male, and 11 were female. The majority of patients suffered from hypercapnic respiratory failure (n=13, 56.5%). At 1 hour and 3 hours, SpO2 and PaO2 displayed excellent correlation (p<0.001, r = 0.943, and p<0.001, r = 0.954, respectively). We did not observe any adverse events associated with the device. Conclusions. Our results indicate that automated oxygen treatment is feasible and safe in hospitalized patients with acute respiratory failure. Further studies are required in order to assess the long-term effects of automated oxygen delivery systems.

Closed–loop oxygen control improves oxygenation in pediatric patients under high–flow nasal oxygen—A randomized crossover study

“…The findings of our study are in line with previous studies testing the efficacy of closed-loop oxygen control in preterm infants and adults (16, [35][36][37][38][39][40][41][42][43][44] receiving HFNO for hypoxemia of various causes. In all those studies, closed-loop oxygen control outperformed healthcare workers performing manual oxygen titrations with respect to the percentage of time spent in target SpO 2 ranges and to the time spent in potentially dangerous SpO 2 zones .…”

Oxygen-induced hypercapnia: physiological mechanisms and clinical implications

“…The FiO2 subsequently should be increased only if the effect of pH is modest [83]. Automated oxygen delivery system may also have a potential role in patients with acute respiratory failure as it helps in controlled oxygen delivery [84]. Agusti et al [85] in a small randomized crossover study involving 18 hospitalised COPD patients with acute respiratory failure demonstrated improvement of oxygen tension by venturi masks and nasal prongs to the same extent, without any significant effect upon hypercarbia.…”

Automatic versus manual oxygen titration using a novel nasal high-flow device in medical inpatients with an acute illness: a randomised controlled trial

“…10 Recently, oxygen delivery systems using a closed-loop feedback system have been developed which enable continuous automated adjustment of a delivered oxygen concentration. [11][12][13][14][15] Studies of these devices have demonstrated patients spend a greater proportion of time with SpO 2 within target range compared with the standard practice of manual oxygen titration both in the emergency department (ED), 12 ward setting 13 and following abdominal and thoracic surgery. 11 To date, studies of automated oxygen titration in adults have involved conventional low-flow oxygen.…”