Automatic<i>versus</i>manual 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 2 ≥3 L·min −1 . Patients were randomised to automated closed-loop or manual O 2 titration during 3 h. Patients were stratified according to arterial carbon dioxide tension ( P aCO 2 ) (hypoxaemic P aCO 2 ≤45 mmHg; or hypercapnic P aCO 2 &gt;45–≤55 mmHg) and study centre. Arterial oxygen saturation measured by pulse oximetry ( S pO 2 ) goals were 92–96% for hypoxaemic, or 88–92% for hypercapnic patients. Primary outcome was % time within S pO 2 target. Secondary endpoints were hypoxaemia and hyperoxia prevalence, O 2 weaning, O 2 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 pO 2 target was higher under automated titration (81±21% versus 51±30%, p&lt;0.001). Time with hypoxaemia (3±9% versus 5±12%, p=0.04) and hyperoxia under O 2 (4±9% versus 22±30%, p&lt;0.001) were lower with automated titration. O 2 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&lt;0.001). O 2 duration during the hospital stay was significantly reduced (5.6±5.4 versus 7.1±6.3 days, p=0.002). Automated O 2 titration in the emergency department improved oxygenation parameters and adherence to guidelines, with potential clinical benefits.