Автономная подача кислорода увеличила время пациентов в норме насыщения на 22% по сравнению с ручным режимом

Autonomous vs. manual oxygen titration yields more time in normoxemia Key takeaways: - Those receiving autonomous oxygen titration spent 85% of time in normoxemia vs. 63% among those receiving manual titration. - In each subgroup, autonomous titration was favored over manual. In acutely ill adults receiving supplemental oxygen, the proportion of time spent in normoxemia was higher with autonomous vs. manual oxygen titration, according to findings published in JAMA Internal Medicine. “Supplemental oxygen is one of the most common clinical interventions in delivering patient care,” Adit A. Ginde, MD, MPH, professor and vice chair for research in the department of emergency medicine at University of Colorado Anschutz School of Medicine, told Healio. “The study findings have potential to change the way that we deliver oxygen to ill and injured patients.” In the multicenter, unblinded, parallel-group, randomized SAVE-O2 AI clinical trial, Ginde and colleagues assessed 300 adults (median age, 66 years; 54% women) hospitalized for acute respiratory illness, trauma, burn or acute care surgery and receiving supplemental oxygen to uncover the impact of autonomous oxygen titration via the O2matic PRO100 (O2matic ApS) vs. manual oxygen titration by clinicians (usual care) on time spent in a targeted normoxemia range of peripheral oxygen saturation (SpO2) 90% to 96%. A press release from O2matic outlined that “the O2matic PRO100 continuously monitors blood oxygen saturation through pulse oximetry and automatically adjusts oxygen flow in real time to help keep patients within a clinician defined target range.” “Our motivation was to meet military needs to evaluate autonomous oxygen titration to improve medical care and logistics for injured and ill service members,” David J. Douin, MD, MSc, associate professor in the department of anesthesiology at the University of Colorado Anschutz School of Medicine, told Healio. Using the Monk Skin Tone Scale, researchers highlighted that 22% of this population had light skin pigmentation, 56% had medium skin pigmentation and 22% had dark skin pigmentation. The group receiving autonomous oxygen titration during the first 72 hours after randomization included 152 patients (median age, 68 years; 57% women; median flow rate changes, 6.8 per day), and the group receiving usual care included the remaining 148 patients (median age, 64 years; 51% women; median flow rate changes, 7.7 per day). According to the study, patients receiving autonomous vs. manual oxygen titration spent a significantly higher proportion of time in normoxemia (mean, 85% vs. 63%; adjusted risk difference, 21 percentage points; 95% CI, 18-25 percentage points; P < .001). Additionally, compared with the manual titration group, the autonomous titration group spent a significantly smaller proportion of time in hypoxemia, classified as a SpO2 less than 88% (mean, 2% vs. 3.6%; adjusted risk difference, –1.3 percentage points; 95% CI, –2 to –0.5 percentage points; P = .002). The study noted consistent findings after dividing the population based on race/ethnicity (non-Hispanic white, non-Hispanic Black, Hispanic, other race/ethnicity), Monk Skin Tone Scale (light, medium, dark), Fitzpatrick Skin Type Scale (light, medium, dark), O2 volume at randomization (1-2.9 L/minute, 3-4.9 L/minute, 5-10 L/minute), dependent on home O2 at admission (no home O2 or home O2 present), primary reason for hospital admission (acute respiratory illness or traumatic injury/burn/acute surgery) and pulmonary comorbidity (yes or no). In each of these groups, autonomous titration was favored over manual titration for proportion of time spent in normoxemia and hypoxemia. “We were pleasantly surprised by how well the device (O2matic PRO100) performed across all skin pigmentation categories, especially because this is an area where other oxygen-related devices have struggled recently,” Douin said. Researchers went on to examine time in hyperoxemia (SpO2 > 96%) and found a smaller proportion of time spent in this state among those receiving autonomous vs. manual oxygen titration (mean, 9.2% vs. 29.1%). This was also the case for borderline hypoxemia, classified as a SpO2 of 88% to 89% (mean, 3.4% vs. 4%). Outcomes that were comparable between those receiving autonomous oxygen titration and those receiving manual oxygen titration included in-hospital mortality to day 28 (four deaths vs. five deaths), median supplemental oxygen-free days and median hospital-free days. “Our next study, which is already underway, will be evaluating the device in the prehospital transport setting, including ground and helicopter transport,” Ginde told Healio. “We are also looking into other hospital settings, such as during recovery from operations.” For more information: David J. Douin, MD, MSc, can be reached at [email protected]. Adit A. Ginde, MD, MPH, can be reached at [email protected].