Automated oxygen titration and weaning with FreeO2 in patients with acute exacerbation of COPD: a pilot randomized trial.
INTRODUCTION
We developed a device (FreeO2) that automatically adjusts the oxygen flow rates based on patients' needs, in order to limit hyperoxia and hypoxemia and to automatically wean them from oxygen.


OBJECTIVE
The aim of this study was to evaluate the feasibility of using FreeO2 in patients hospitalized in the respiratory ward for an acute exacerbation of COPD.


METHODS
We conducted a randomized controlled trial comparing FreeO2 vs manual oxygen titration in the respiratory ward of a university hospital. We measured the perception of appropriateness of oxygen titration and monitoring in both groups by nurses and attending physicians using a Likert scale. We evaluated the time in the target range of oxygen saturation (SpO2) as defined for each patient by the attending physician, the time with severe desaturation (SpO2 <85%), and the time with hyperoxia (SpO2 >5% above the target). We also recorded length of stay, intensive care unit admissions, and readmission rate. Fifty patients were randomized (25 patients in both groups; mean age: 72±8 years; mean forced expiratory volume in 1 second: 1.00±0.49 L; and mean initial O2 flow 2.0±1.0 L/min).


RESULTS
Nurses and attending physicians felt that oxygen titration and monitoring were equally appropriate with both O2 administration systems. The percentage of time within the SpO2 target was significantly higher with FreeO2, and the time with severe desaturation and hyperoxia was significantly reduced with FreeO2. Time from study inclusion to hospital discharge was 5.8±4.4 days with FreeO2 and 8.4±6.0 days with usual oxygen administration (P=0.051).


CONCLUSION
FreeO2 was deemed as an appropriate oxygen administration system by nurses and physicians of a respiratory unit. This system maintained SpO2 at the target level better than did manual titration and reduced periods of desaturation and hyperoxia. Our results also suggest that FreeO2 has the potential to reduce the hospital length of stay.
['Lellouche|François|F|', 'Bouchard|Pierre-Alexandre|PA|', 'Roberge|Maude|M|', 'Simard|Serge|S|', "L'Her|Erwan|E|", 'Maltais|François|F|', 'Lacasse|Yves|Y|']
D000368:Aged D000369:Aged, 80 and over D001291:Attitude of Health Personnel D015415:Biomarkers D004867:Equipment Design D005240:Feasibility Studies D005260:Female D007722:Health Knowledge, Attitudes, Practice D006760:Hospitalization D006785:Hospitals, University D006801:Humans D018496:Hyperoxia D000860:Hypoxia D008168:Lung D008297:Male D008505:Medical Staff, Hospital D008875:Middle Aged D009741:Nursing Staff, Hospital D010100:Oxygen D010102:Oxygen Inhalation Therapy D010865:Pilot Projects D029424:Pulmonary Disease, Chronic Obstructive D011792:Quebec D013997:Time Factors D016896:Treatment Outcome
hyperoxia closed-loop hypoxia oxygen inhalation therapy technological innovations