Evaluation of hyperoxia-induced hypercapnia in obese patients after cardiac surgery: a randomized crossover comparison of conservative and liberal oxygen administration

Clinical Implementation of Automated Oxygen Titration in a Tertiary Care Hospital

“…For example, detailed SpO 2 data could only be retrieved for 13% of subjects; due to the fact that many were not appropriately identified in the device making it impossible to match recorded oxygenation data with the corresponding subjects. Although the availability of detailed SpO 2 data in only a small portion of subjects raises questions about the external validity of the findings, we were reassured that the proportion of time spent within the SpO 2 targets was similar to that previously observed in other clinical circumstances [10][11][12][14][15][16][17] . Only a small number of nurses and respiratory therapists responded to the survey about the utilization of automated O 2 titration.…”

“…Discussion We report our clinical experience with the feasibility of using an automated O 2 titration device in subjects with acute respiratory failure requiring O 2 therapy as a part of their routine clinical care. The cumulative data during this evaluation extends previous clinical trials in showing that the ability of automated O 2 titration to maintain SpO 2 within the desired range in various diseases [10][11][12][14][15][16][17] may also apply to "real life" clinical situations. Clinical worsening, defined as the requirement for high flow nasal oxygen and/or transfer to the intensive care unit in 96 subjects (15.8%) was attributed to progression of the underlying disease.…”

“…Automated O 2 titration in response to SpO 2 fluctuations was more effective than manual O 2 titration to maintain subjects in the desirable SpO 2 range as previously reported in a variety of clinical situations such as critically injured trauma subjects 10 , in subjects admitted to the emergency departement 12 , following thoracic or abdominal surgery 15 , acute COPD exacerbation 11,14 , exercise in subjects with chronic lung diseases 19 , and in the pediatric population 30 . Typically, SpO 2 is maintained in the therapeutic zone 80% of the time with automated O 2 titration compared to 40 to 55% of the time with manual O 2 titration [10][11][12][14][15][16][17] . Considering the importance of avoiding both hyperoxemia and hypoxemia 31 , the goal of maintaining subjects within a safe SpO 2 target zone is an argument in favor of automated O 2 adjustment when caring for subjects with hypoxemic respiratory failure.…”

“…Automated O 2 titration with devices that are based on closed-loop algorithms has been developed with the objective of maintaining SpO 2 by providing continuous adjustment of O 2 flows in the context of fluctuating oxygen requirements 13,14 . These devices have been shown to increase the proportion of time spent in the desired SpO 2 range in various clinical situations, including hospitalized subjects with acute COPD exacerbation 11,14 , subjects in the emergency department 12 , following surgery 15,16 , and in COVID-19 related hypoxemic respiratory failure 17 . Automated O 2 titration has also been shown to be effective in situations where rapid adjustments of O 2 flows is required, such as during exercise [18][19][20] .…”

Closed-loop oxygen control for patients with hypoxaemia during hospitalisation: a living systematic review and meta-analysis protocol

“…11 12 The adoption of new technologies of AI and ML in clinical practice, may reduce the healthcare professionals' workload at the bedside; however, there is low certainty evidence for their safety and benefits. 11 12 It is still unclear whether closed-loop oxygen control devices could improve clinical outcomes, and with the technological advances, new randomised clinical trials (RCTs) [13][14][15][16][17][18][19][20][21] have been published since the last two systematics reviews were conducted. 11 12 Thus, the aim of this systematic review is to investigate the effectiveness, efficacy and safety of the closed-loop oxygen control for patients during hospitalisation.…”