Automated closed-loop versus standard manual oxygen administration after major abdominal or thoracic surgery: an international multicentre randomised controlled study

IntroductionHypoxaemia and hyperoxaemia may occur after surgery, with related complications. This multicentre randomised trial evaluated the impact of automated closed-loop oxygen administration after high-risk abdominal or thoracic surgeries in terms of optimising the oxygen saturation measured by pulse oximetry time within target range.MethodsAfter extubation, patients with an intermediate to high risk of post-operative pulmonary complications were randomised to “standard” or “automated” closed-loop oxygen administration. The primary outcome was the percentage of time within the oxygenation range, during a 3-day frame. The secondary outcomes were the time with hypoxaemia and hyperoxaemia under oxygen.ResultsAmong the 200 patients, time within range was higher in the automated group, both initially (≤3 h; 91.4±13.7% versus 40.2±35.1% of time, difference +51.0% (95% CI −42.8–59.2%); pversus 62.1±23.3% of time, difference +31.9% (95% CI 26.3–37.4%); pversus 370.5±594.3 min (5.0±11.2%), difference −10.2% (95% CI −13.9–−6.6%); pversus 177.9±277.2 min (27.0±23.8%), difference −22.0% (95% CI −27.6–−16.4%); p10% of the entire monitoring time during the 3 days within the standard group, as compared to the automated group (pConclusionAutomated closed-loop oxygen administration promotes greater time within the oxygenation target, as compared to standard manual administration, thus reducing the occurrence of hypoxaemia and hyperoxaemia.