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 O₂ ≥3 L·min^-1 Patients were randomised to automated closed-loop or manual O₂ titration during 3 h. Patients were stratified according to arterial carbon dioxide tension (P_aCO₂ ) (hypoxaemic P_aCO₂ ≤45 mmHg; or hypercapnic P_aCO₂ >45-≤55 mmHg) and study centre. Arterial oxygen saturation measured by pulse oximetry (S_pO₂ ) goals were 92-96% for hypoxaemic, or 88-92% for hypercapnic patients. Primary outcome was % time within S_pO₂ target. Secondary endpoints were hypoxaemia and hyperoxia prevalence, O₂ weaning, O₂ 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 S_pO₂ target was higher under automated titration (81±21% versus 51±30%, p<0.001). Time with hypoxaemia (3±9% versus 5±12%, p=0.04) and hyperoxia under O₂ (4±9% versus 22±30%, p<0.001) were lower with automated titration. O₂ could be weaned at the end of the study in 14.1% versus 4.3% patients in the automated and manual titration group, respectively (p<0.001). O₂ duration during the hospital stay was significantly reduced (5.6±5.4 versus 7.1±6.3 days, p=0.002).Automated O₂ titration in the emergency department improved oxygenation parameters and adherence to guidelines, with potential clinical benefits.

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