Clinical Implementation of Automated Oxygen Titration in a Tertiary Care Hospital

• Published in: Respiratory care Vol. 69; no. 9; p. 1081
• Main Authors: Bouchard, Pierre-Alexandre, Parent-Racine, Geneviève, Paradis-Gagnon, Cassiopée, Simon, Mathieu, Lacasse, Yves, Lellouche, François, Maltais, François
• Format: Journal Article
• Language: English
• Published: United States 01.09.2024
• Subjects: Adult; Aged; COVID-19 - complications; COVID-19 - therapy; Feasibility Studies; Female; Health Personnel; Humans; Hyperoxia - etiology; Hypoxia - etiology; Hypoxia - therapy; Male; Middle Aged; Oxygen - administration & dosage; Oxygen - blood; Oxygen Inhalation Therapy - instrumentation; Oxygen Inhalation Therapy - methods; Oxygen Saturation; Respiratory Insufficiency - therapy; Tertiary Care Centers; respiratory failure; hypoxemia; oxygen saturation; oxygen supplementation; automated oxygen titration; hyperoxemia
• ISSN: 1943-3654; 0020-1324; 1943-3654
• DOI: 10.4187/respcare.11331

When treating acute respiratory failure, both hypoxemia and hyperoxemia should be avoided. S should be monitored closely and O flows adjusted accordingly. Achieving this goal might be easier with automated O titration compared with manual titration of fixed-flow O . We evaluated the feasibility of using an automated O titration device in subjects treated for acute hypoxemic respiratory failure in a tertiary care hospital. Health-care workers received education and training about oxygen therapy, and were familiarized with an automated O titration device (FreeO ). A coordinator was available from 8:00 am to 5:00 pm during weekdays to provide technical assistance. The ability of the device to maintain S within the prescribed therapeutic window was recorded. Basic clinical information was recorded. Subjects were enrolled from November 2020 to August 2022. We trained 508 health-care workers on the use of automated O titration, which was finally used on 872 occasions in 763 subjects, distributed on the respiratory, COVID-19, and thoracic surgery wards, and in the emergency department. Clinical information could be retrieved for 609 subjects (80%) who were on the system for a median (interquartile range) of 3 (2-6) d, which represented 2,567 subject-days of clinical experience with the device. In the 82 subjects (14%) for whom this information was available, the system maintained S within the prescribed targets 89% of the time. Ninety-six subjects experienced clinical deterioration as defined by the need to be transferred to the ICU and/or requirement of high flow nasal oxygen but none of these events were judged to be related to the O device. Automated O titration could be successfully implemented in hospitalized subjects with hypoxemic respiratory failure from various causes. This experience should foster further improvement of the device and recommendations for an optimized utilization.