Automated Oxygen Titration With Noninvasive Respiratory Support in Acute In-Patient Care.

When delivering high-flow nasal cannula (HFNC) therapy, automated oxygen titration increases time spent within a target S range compared with manually adjusted titration. This trial explored if this benefit is also achieved when CPAP or noninvasive ventilation (NIV) is used. This open label exploratory study randomized participants to automated oxygen titration or manual oxygen titration using a single respiratory support device capable of delivering HFNC, CPAP, and NIV. Participants were hospital in-patients requiring supplemental oxygen and one or more of HFNC, CPAP, and NIV; and could interchange between the three modalities according to clinical need. The primary outcome was the proportion of time spent within a target S range in participants who received ≥8 h of therapy. A secondary interaction analysis explored whether any difference between automated and manual titration differed by respiratory support modality. A total of 68 participants received randomized therapy; 58 started on HFNC, 6 on CPAP, and 4 on NIV. A total of 62 had data for the primary end point, with median (interquartile range) proportion of time spent within the target S range with automated oxygen ( 32) of 91.4% (84.3 to 97.5) versus 75.9% (64.0 to 87.8) with manually adjusted oxygen ( 30); difference 13.9% (95% confidence interval 6.2-21.2), < .001. The difference between automated and manual titration did not depend on respiratory support modality, -interaction = .94. In hospitalized subjects predominantly receiving HFNC, automated oxygen titration had the effect of increasing time spent within a target S range compared with manual oxygen titration. Automated oxygen titration had a similar effect on a small subset of participants receiving CPAP and NIV.