Automatic Versus Manual Oxygen Titration Using A Novel Nasal High-Flow Device In Medical Inpatients With An Acute Illness: A Randomised Controlled Trial

Background Guideline recommendations state oxygen should be administered to acutely unwell patients to achieve a target oxygen saturation (SpO(2)) range. The current practice of manual oxygen titration frequently results in SpO(2) 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 SpO(2) 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 SpO(2) 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 SpO(2) 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 SpO(2) >= 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 SpO(2) in target range compared with manual titration.