Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts contributed to the development of this briefing. Only 1 expert had experience of using the technology in less than 5 people. Another expert was familiar with the use of fixed oxygen delivery and monitoring devices used in acute settings, high dependency units and outpatient settings. The other expert had no experience with the technology or any similar automated oxygen titration devices. The experts were not aware of use of the technology in the NHS and only 1 has been involved in some research on this technology.

Level of innovation

The 3 experts considered the technology to be an innovative approach to maintaining oxygen saturation through automatically titrating inspired oxygen. Two experts reported that there are other similar devices available such as FreeO2 and Airvo3. Airvo3 is a nasal high flow device that can automatically titrate delivered oxygen to a set target saturation. One of the experts added that O2matic PRO 100 differs from Airvo3 because it can be used with usual nasal oxygen and nasal high flow devices.

Potential patient impact

According to the experts, the main patient benefit would be keeping the oxygen saturation within a set range for a greater amount of time with fewer deviations. They advised that the technology may reduce the risk of harm because of uncontrolled oxygen delivery, that is, oxygen saturation levels that are too high or too low that can happen in periods between nursing observations. Experts also said the technology may help with oxygen weaning. One expert noted that the ability to download patient data to monitor flow and oxygen saturation trends over a 24‑hour period may be a useful tool to help discharge people from hospital.

The experts stated that the technology has the potential to replace current standard care but it is unlikely to do so because of the high number of people who need oxygen therapy. Therefore, the experts considered it most likely to be used in specific patient groups who are at the highest risk of deviations in oxygen saturations. They advised that the technology is likely to be most beneficial for people at risk of hypercapnic respiratory failure because of oxygen sensitivity. This includes people with chronic obstructive pulmonary disease (COPD) with carbon-dioxide retention, people with neurological causes of respiratory failure, people with chest wall disease and people with obesity hypoventilation syndrome.

One expert referenced the potential benefits as shown in the study by Kofod et al. (2021) that ambulatory oxygen delivery and auto-titration may be beneficial in exercise capacity and reduction in dyspnoea.

Potential system impact

The experts noted that the technology would cost more than standard care for capital outlay but potentially offset downstream costs because of reduced nursing time needed for observations and manually adjusted oxygen flows. However, 1 expert cautioned that the resource savings for nurse time would be limited because nurses would still be needed to record other observations for acutely ill people such as pulse and blood pressure monitoring. The technology also has the potential to reduce length of hospital stay, but evidence supporting this is needed.

General comments

The experts said that adopting the technology would not need changes to the existing facilities in a hospital setting. An expert highlighted that more than 1,000 people having treatment in a mid-sized district general hospital could benefit from this technology. Furthermore, there are significant numbers of people who need emergency oxygen therapy.

The experts highlighted the lack of evidence of clinical efficacy and system impact (such as reduced length of hospital stay). They noted the need for larger studies across different patient groups to assess the benefits and safety of the technology. Important outcomes include increased time with oxygen saturation kept within a target range, reduced time of oxygen saturation kept outside of a target range, reduced length of hospital stay, reduced need for close nursing contact with people with COVID‑19 therefore reduced risk of infection transmission and improvement in exercise capacity in ambulatory patients with COPD. In addition, more information is needed on technical problems with the device, saturation pick up rates and loss of signal time.

An expert raised potential issues and harms from the technology. The expert mentioned that the Kofod et al. (2021) study reported that there were episodes of loss of signal from the saturation monitoring device although this was similar in the intervention and usual care groups. This could potentially cause a risk of oxygen not being titrated accordingly and therefore too much or too little oxygen being delivered (as reported in the Hansen et al. 2018 study). In the same study it was noted that audible and visual alarms for alerting there was no power supply were ignored and the oxygen supply shut down after 2 hours. Discomfort because of very high oxygen flow rates by nasal cannulae was reported but 1 of the experts said this could be mitigated by switching to a nasal high flow system.