Manual compared to automated closed-loop oxygen control strategies in hospitalised adults: a systematic review and meta-analysis.
Louis Kirton, Rowan Biggs, Neakiry Kivi et al.
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In 30 seconds
This systematic review and meta-analysis assessed randomised controlled trials comparing closed-loop oxygen control (CLOC) with manual adjustment in hospitalised adults receiving noninvasive oxygen. Seven trials involving 635 participants were included. CLOC increased the mean proportion of time within the target peripheral oxygen saturation range by 21.2% (95% CI 18.5-23.8, p<0.0001). The advantage varied by oxygen delivery mode: the mean difference was 30.9% with low-flow oxygen and 12.7% with high-flow nasal oxygen. The review excluded outpatient studies and studies involving mechanical ventilation.
Key findings
- Across seven trials and 635 participants, CLOC increased time within the target SpO₂ range by 21.2% (95% CI 18.5-23.8, p<0.0001).
- For low-flow oxygen, the mean difference favouring CLOC was 30.9% (95% CI 27.0-34.8, p<0.0001).
- For high-flow nasal oxygen, the mean difference favouring CLOC was 12.7% (95% CI 9.1-16.4, p<0.001).
- Between-study heterogeneity was substantial (I²=87.9) and was explained by oxygen delivery mode.
Why it matters
Maintaining oxygen saturation within a prescribed range is a practical challenge during hospital oxygen therapy. These pooled trial findings indicate that automated control can improve target-range adherence compared with manual adjustment across noninvasive delivery methods. The differing estimates by oxygen mode also suggest that the size of the benefit may depend on how oxygen is delivered.
What to keep in mind
The evidence comprised seven trials, with substantial heterogeneity (I²=87.9); the review excluded outpatient and mechanically ventilated populations.