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

Abstract

Background Guideline recommendations state oxygen should be administered to acutely unwell patients to achieve a target oxygen saturation (SpO2) range. The current practice of manual oxygen titration frequently results in SpO2 outside of a prescribed range. The aim of this study was to assess the efficacy of automatic oxygen titration using a closed-loop feedback system to achieve SpO2 within a prescribed target rangeMethods An open-label randomised parallel group trial was undertaken comparing automatic oxygen titration using a novel nasal high-flow device to manual oxygen titration using nasal high flow. Medical inpatients requiring oxygen therapy in Wellington Regional Hospital, New Zealand with a prescribed target SpO2 range of 88%–92% or 92%–96% were recruited and randomised equally between the interventions for a period of 24 hours. The primary outcome was the proportion of time spent with SpO2 within the prescribed range.Results 20 patients were included in the analysis. Automatic oxygen titration resulted in a median (IQR) 96.2% (95.2–97.8) of time within the target range compared with 71% (59.4–88.3) with manual titration; difference (95% CI) 24.2% (7.9% to 35%), p<0.001. There was a reduction in the time spent with SpO2 ≥2% above and ≥2% below range in the automatic titration group, although the point estimate for the differences were small; −1% (−8.2% to −0.04%), p=0.017 and −2.4% (−11.5% to 0.3%), p=0.05 respectively.Conclusions Nasal high-flow with automatic oxygen titration resulted in a greater proportion of time spent with SpO2 in target range compared with manual titration.Trial registration The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000901101).