AUTHOR=Sandal Ozlem , Ceylan Gokhan , Topal Sevgi , Hepduman Pinar , Colak Mustafa , Novotni Dominik , Soydan Ekin , Karaarslan Utku , Atakul Gulhan , Schultz Marcus J. , Ağın Hasan 

TITLE=Closed–loop oxygen control improves oxygenation in pediatric patients under high–flow nasal oxygen—A randomized crossover study

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.1046902

DOI=10.3389/fmed.2022.1046902

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>We assessed the effect of a closed–loop oxygen control system in pediatric patients receiving high–flow nasal oxygen therapy (HFNO).</p></sec><sec><title>Methods</title><p>A multicentre, single–blinded, randomized, and cross–over study. Patients aged between 1 month and 18 years of age receiving HFNO for acute hypoxemic respiratory failure (AHRF) were randomly assigned to start with a 2–h period of closed–loop oxygen control or a 2–h period of manual oxygen titrations, after which the patient switched to the alternative therapy. The endpoints were the percentage of time spent in predefined SpO<sub>2</sub> ranges (primary), FiO<sub>2</sub>, SpO<sub>2</sub>/FiO<sub>2</sub>, and the number of manual adjustments.</p></sec><sec><title>Findings</title><p>We included 23 patients, aged a median of 18 (3–26) months. Patients spent more time in a predefined optimal SpO<sub>2</sub> range when the closed–loop oxygen controller was activated compared to manual oxygen titrations [91⋅3% (IQR 78⋅4–95⋅1%) vs. 63⋅0% (IQR 44⋅4–70⋅7%)], mean difference [28⋅2% (95%–CI 20⋅6–37⋅8%); <italic>P</italic> &lt; 0.001]. Median FiO<sub>2</sub> was lower [33⋅3% (IQR 26⋅6–44⋅6%) vs. 42⋅6% (IQR 33⋅6–49⋅9%); <italic>P</italic> = 0.07], but median SpO<sub>2</sub>/FiO<sub>2</sub> was higher [289 (IQR 207–348) vs. 194 (IQR 98–317); <italic>P</italic> = 0.023] with closed–loop oxygen control. The median number of manual adjustments was lower with closed–loop oxygen control [0⋅0 (IQR 0⋅0–0⋅0) vs. 0⋅5 (IQR 0⋅0–1⋅0); <italic>P</italic> &lt; 0.001].</p></sec><sec><title>Conclusion</title><p>Closed-loop oxygen control improves oxygenation therapy in pediatric patients receiving HFNO for AHRF and potentially leads to more efficient oxygen use. It reduces the number of manual adjustments, which may translate into decreased workloads of healthcare providers.</p></sec><sec><title>Clinical trial registration</title><p>[<ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>], identifier [NCT 05032365].</p></sec>