• Oriol Roca, Oriol Caritg, Manel Santafé, Francisco J Ramos, Andrés Pacheco, Marina García-de-Acilu, Ricard Ferrer, Marcus J Schultz, and Jean-Damien Ricard.
• Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron and Institut de Recerca Vall d'Hebron, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain. oroca@vhebron.net.
• Crit Care. 2022 Apr 14; 26 (1): 108.

BackgroundWe aimed to assess the efficacy of a closed-loop oxygen control in critically ill patients with moderate to severe acute hypoxemic respiratory failure (AHRF) treated with high flow nasal oxygen (HFNO).MethodsIn this single-centre, single-blinded, randomized crossover study, adult patients with moderate to severe AHRF who were treated with HFNO (flow rate ≥ 40 L/min with FiO2 ≥ 0.30) were randomly assigned to start with a 4-h period of closed-loop oxygen control or 4-h period of manual oxygen titration, after which each patient was switched to the alternate therapy. The primary outcome was the percentage of time spent in the individualized optimal SpO2 range.ResultsForty-five patients were included. Patients spent more time in the optimal SpO2 range with closed-loop oxygen control compared with manual titrations of oxygen (96.5 [93.5 to 98.9] % vs. 89 [77.4 to 95.9] %; p < 0.0001) (difference estimate, 10.4 (95% confidence interval 5.2 to 17.2). Patients spent less time in the suboptimal range during closed-loop oxygen control, both above and below the cut-offs of the optimal SpO2 range, and less time above the suboptimal range. Fewer number of manual adjustments per hour were needed with closed-loop oxygen control. The number of events of SpO2 < 88% and < 85% were not significantly different between groups.ConclusionsClosed-loop oxygen control improves oxygen administration in patients with moderate-to-severe AHRF treated with HFNO, increasing the percentage of time in the optimal oxygenation range and decreasing the workload of healthcare personnel. These results are especially relevant in a context of limited oxygen supply and high medical demand, such as the COVID-19 pandemic. Trial registration The HILOOP study was registered at www.Clinicaltrialsgov under the identifier NCT04965844 .© 2022. The Author(s).

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