Abstract
Background: We aimed to assess the efficacy of a closed-loop oxygen control in critically ill patients with moderate to severe acute hypoxemic respiratory failure (AHRF) treated with high flow nasal oxygen (HFNO).
Methods: In this single-centre, single-blinded, randomized crossover study, adult patients with moderate to severe AHRF who were treated with HFNO (flow rate ≥ 40 L/min with FiO 2 ≥ 0.30) were randomly assigned to start with a 4-h period of closed-loop oxygen control or 4-h period of manual oxygen titration, after which each patient was switched to the alternate therapy. The primary outcome was the percentage of time spent in the individualized optimal SpO 2 range.
Results: Forty-five patients were included. Patients spent more time in the optimal SpO 2 range with closed-loop oxygen control compared with manual titrations of oxygen (96.5 [93.5 to 98.9] % vs. 89 [77.4 to 95.9] %; p < 0.0001) (difference estimate, 10.4 (95% confidence interval 5.2 to 17.2). Patients spent less time in the suboptimal range during closed-loop oxygen control, both above and below the cut-offs of the optimal SpO 2 range, and less time above the suboptimal range. Fewer number of manual adjustments per hour were needed with closed-loop oxygen control. The number of events of SpO 2 < 88% and < 85% were not significantly different between groups.
Conclusions: Closed-loop oxygen control improves oxygen administration in patients with moderate-to-severe AHRF treated with HFNO, increasing the percentage of time in the optimal oxygenation range and decreasing the workload of healthcare personnel. These results are especially relevant in a context of limited oxygen supply and high medical demand, such as the COVID-19 pandemic. Trial registration The HILOOP study was registered at www.
Clinicaltrials: gov under the identifier NCT04965844 .
Keywords: Acute respiratory failure; Automatic oxygen titration; Closed-loop oxygen control; High flow nasal cannula; High-flow nasal oxygen; Nasal high-flow.
【저자키워드】 High-flow nasal oxygen, Acute respiratory failure, High flow nasal cannula, Automatic oxygen titration, Closed-loop oxygen control, Nasal high-flow., 【초록키워드】 Efficacy, therapy, Respiratory failure, COVID-19 pandemic, oxygen, nasal, Randomized, Patient, moderate, healthcare personnel, Oxygenation, Critically ill patient, Oxygen administration, AHRF, Primary outcome, HFNO, oxygen supply, 95% confidence interval, Registered, cut-off, hypoxemic, event, Randomly, IMPROVE, treated, less, assigned, groups, Automatic, nasal oxygen, not significantly different, patients with moderate, 【제목키워드】 Respiratory failure, oxygen, nasal, Randomized, Patient, Oxygen therapy, hypoxemic, IMPROVE, cross-over,