Automated oxygen titration and weaning with FreeO(2) in patients with acute exacerbation of COPD: a pilot randomized trial

INTRODUCTION: We developed a device (FreeO(2)) 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 FreeO(2) in patients hospitalized in the respiratory ward for an acute exacerbation of COPD. METHODS: We conducted a randomized controlled trial comparing FreeO(2) 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 (SpO(2)) as defined for each patient by the attending physician, the time with severe desaturation (SpO(2) <85%), and the time with hyperoxia (SpO(2) >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 O(2) flow 2.0±1.0 L/min). RESULTS: Nurses and attending physicians felt that oxygen titration and monitoring were equally appropriate with both O(2) administration systems. The percentage of time within the SpO(2) target was significantly higher with FreeO(2), and the time with severe desaturation and hyperoxia was significantly reduced with FreeO(2). Time from study inclusion to hospital discharge was 5.8±4.4 days with FreeO(2) and 8.4±6.0 days with usual oxygen administration (P=0.051). CONCLUSION: FreeO(2) was deemed as an appropriate oxygen administration system by nurses and physicians of a respiratory unit. This system maintained SpO(2) at the target level better than did manual titration and reduced periods of desaturation and hyperoxia. Our results also suggest that FreeO(2) has the potential to reduce the hospital length of stay.