Automaticversusmanual oxygen administration in the emergency department

Abstract

Oxygen is commonly administered in hospitals, with poor adherence to treatment recommendations.We conducted a multicentre randomised controlled study in patients admitted to the emergency department requiring O ≥3 L·min Patients were randomised to automated closed-loop or manual O titration during 3 h. Patients were stratified according to arterial carbon dioxide tension ( ) (hypoxaemic ≤45 mmHg; or hypercapnic >45-≤55 mmHg) and study centre. Arterial oxygen saturation measured by pulse oximetry ( ) goals were 92-96% for hypoxaemic, or 88-92% for hypercapnic patients. Primary outcome was % time within target. Secondary endpoints were hypoxaemia and hyperoxia prevalence, O weaning, O duration and hospital length of stay.187 patients were randomised (93 automated, 94 manual) and baseline characteristics were similar between the groups. Time within the target was higher under automated titration (81±21% 51±30%, p<0.001). Time with hypoxaemia (3±9% 5±12%, p=0.04) and hyperoxia under O (4±9% 22±30%, p<0.001) were lower with automated titration. O could be weaned at the end of the study in 14.1% 4.3% patients in the automated and manual titration group, respectively (p<0.001). O duration during the hospital stay was significantly reduced (5.6±5.4 7.1±6.3 days, p=0.002).Automated O titration in the emergency department improved oxygenation parameters and adherence to guidelines, with potential clinical benefits.

Automatic oxygen flow titration in spontaneously breathing children: An open‐label randomized controlled pilot study

“…Its safety and efficacy for increasing the time spent in the target SpO 2 range have been reported in adults. [19][20][21][22] A recent study showed that FreeO2 technology could be more cost-effective than manual oxygen administration, reducing the per-patient costs over 180 days in an adult population with chronic obstructive pulmonary disease (COPD). 23 In the present study, we aimed to examine the safety of the FreeO2 device-an automated closed-loop O 2 titration technologyand its efficacy for maintaining SpO 2 within a target zone during AHRD in infants and children.…”

Intelligent oxygen delivery in the acute setting: “Don't think twice, it's all right”

“…In an era of precision medicine, the current study published in the ERJ [24] confirms the efficacy of this automated closed loop inspiratory oxygen fraction system for adults with acute respiratory failure, and suggests a "one size fits all" approach may no longer be supported. Long-term studies with other clinical outcomes and cost-benefit analyses are warranted.…”

“…This study leaves some potential unanswered questions: Does the system described by L'HER et al [24] have the same performance with different interfaces (the face mask used here versus the nasal cannula in their previous studies [23])? Is the oximeter used sensitive enough to correct artefactual causes of hypoxaemia (like low perfusion and motion)?…”

“…L'HER et al [24], in the largest multicentre randomised controlled trial of automated oxygen titration of patients with acute respiratory failure, found that the closed-loop system achieved a better control of oxygenation, with a shorter duration of oxygen therapy and hospital stay.…”

Oxygen Therapy in COPD

“…A least one system is FDA-cleared. 88 Lellouche and colleagues [91][92][93][94] have generated much of this work, using a system known as FreeO 2 . They demonstrated efficacy and greater duration of time in desired saturation ranges compared with traditional oxygen therapy during exercise, during COPD exacerbations, and in emergency care.…”