Automated oxygen titration and weaning with FreeO2 in patients with acute exacerbation of COPD: a pilot randomized trial

François Lellouche, Pierre-Alexandre Bouchard, Maude Roberge, Serge Simard, Erwan L'Her, François Maltais, Yves Lacasse, François Lellouche, Pierre-Alexandre Bouchard, Maude Roberge, Serge Simard, Erwan L'Her, François Maltais, Yves Lacasse

Abstract

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.

Keywords: closed-loop; hyperoxia; hypoxia; oxygen inhalation therapy; technological innovations.

Figures

Figure 1
Figure 1
Main features of the FreeO2: oxygen automated titration and weaning with SpO2–O2 flow closed-loop and monitoring. Notes: The FreeO2 adjusts the oxygen flow rate from 0 L/min to 20 L/min (flow accuracy ±0.1 L/min) every second, based on the patient’s needs. A proportional integral controller adjusts the oxygen flow based on the difference between the SpO2 target set by clinicians and the continuously measured SpO2. Several cardiorespiratory parameters are continuously recorded (O2 flow rate, SpO2, respiratory rate, and heart rate), and trends for these parameters are available for clinicians. Both heart rate and respiratory rate are derived from the pulse oximeter plethysmographic wave form. The version used in the study was a previous version of the device with similar technical features.
Figure 2
Figure 2
Flow chart of the study. Note:*Based on administrative records of the institution. Abbreviations: MDR, multidrug resistant; NIV, noninvasive ventilation.
Figure 3
Figure 3
Percentage of time in the SpO2 target (A), with hyperoxia and with severe hypoxemia (B) with FreeO2 (black bars) and with manual adjustment (white bars). Notes: *P<0.001. **P=0.01.

References

    1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for chronic obstructive lung disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256–1276.
    1. Hale KE, Gavin C, O’Driscoll BR. Audit of oxygen use in emergency ambulances and in a hospital emergency department. Emerg Med J. 2008;25(11):773–776.
    1. Aubier M, Murciano D, Fournier M, Milic-Emili J, Pariente R, Derenne JP. Central respiratory drive in acute respiratory failure of patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1980;122(2):191–199.
    1. Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462.
    1. Beasley R, Patel M, Perrin K, O’Driscoll BR. High-concentration oxygen therapy in COPD. Lancet. 2011;378(9795):969–970.
    1. Sassoon CS, Hassell KT, Mahutte CK. Hyperoxic-induced hypercapnia in stable chronic obstructive pulmonary disease. Am Rev Respir Dis. 1987;135(4):907–911.
    1. Mithoefer JC, Karetzky MS, Mead GD. Oxygen therapy in respiratory failure. N Engl J Med. 1967;277(18):947–949.
    1. Plant PK, Owen JL, Elliott MW. One year period prevalence study of respiratory acidosis in acute exacerbations of COPD: implications for the provision of non-invasive ventilation and oxygen administration. Thorax. 2000;55(7):550–554.
    1. Warren PM, Flenley DC, Millar JS, Avery A. Respiratory failure revisited: acute exacerbations of chronic bronchitis between 1961–68 and 1970–76. Lancet. 1980;1(8166):467–470.
    1. Claure N, Bancalari E. Automated closed loop control of inspired oxygen concentration. Respir Care. 2013;58(1):151–161.
    1. Lellouche F, L’Her E. Automated oxygen flow titration to maintain constant oxygenation. Respir Care. 2012;57(8):1254–1262.
    1. Rice KL, Schmidt MF, Buan JS, Lebahn F, Schwarzock TK. A portable, closed-loop oxygen conserving device for stable COPD patients: comparison with fixed dose delivery systems. Respir Care. 2011;56(12):1901–1905.
    1. Cirio S, Nava S. Pilot study of a new device to titrate oxygen flow in hypoxic patients on long-term oxygen therapy. Respir Care. 2011;56(4):429–434.
    1. Lellouche F, Maltais F, Bouchard PA, Brouillard C, L’Her E. FreeO2: closed-loop adaptation of oxygen flow based on SpO2. Evaluation in COPD patients during effort. Respir Care. 2016
    1. Claure N, D’Ugard C, Bancalari E. Automated adjustment of inspired oxygen in preterm infants with frequent fluctuations in oxygenation: a pilot clinical trial. J Pediatr. 2009;155(5):640-5.e1–640-5.e2.
    1. Claure N, Gerhardt T, Everett R, Musante G, Herrera C, Bancalari E. Closed-loop controlled inspired oxygen concentration for mechanically ventilated very low birth weight infants with frequent episodes of hypoxemia. Pediatrics. 2001;107(5):1120–1124.
    1. L’Her E, Dias P, Gouillou M, et al. Automatisation of oxygen titration in patients with acute respiratory distress at the emergency department. A multicentric international randomized controlled study. Am J Respir Critic Care Med. 2015;191:A6329.
    1. Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010;10:231.
    1. Vanfleteren LE, Franssen FM, Uszko-Lencer NH, et al. Frequency and relevance of ischemic electrocardiographic findings in patients with chronic obstructive pulmonary disease. Am J Cardiol. 2011;108(11):1669–1674.
    1. Farquhar H, Weatherall M, Wijesinghe M, et al. Systematic review of studies of the effect of hyperoxia on coronary blood flow. Am Heart J. 2009;158(3):371–377.
    1. McNulty PH, King N, Scott S, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol. 2005;288(3):H1057–H1062.
    1. Galatius-Jensen S, Hansen J, Rasmussen V, Bildsoe J, Therboe M, Rosenberg J. Nocturnal hypoxaemia after myocardial infarction: association with nocturnal myocardial ischaemia and arrhythmias. Br Heart J. 1994;72(1):23–30.
    1. Gogenur I, Rosenberg-Adamsen S, Lie C, Carstensen M, Rasmussen V, Rosenberg J. Relationship between nocturnal hypoxaemia, tachycardia and myocardial ischaemia after major abdominal surgery. Br J Anaesth. 2004;93(3):333–338.
    1. Cousins JL, Wark PA, McDonald VM. Acute oxygen therapy: a review of prescribing and delivery practices. Int J Chron Obstruct Pulmon Dis. 2016;11:1067–1075.
    1. Brill SE, Wedzicha JA. Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2014;9:1241–1252.

Source: PubMed

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