Advice
The technology
The technology
O2matic PRO 100 (O2matic ApS) is an oxygen treatment optimisation device. The device measures blood oxygen saturation (SpO2) and automatically adjusts the flow of oxygen to the person to achieve and maintain a target SpO2. The company states that O2matic PRO 100 is intended for use in respiratory diseases such as chronic obstructive pulmonary disease (COPD), COVID‑19, asthma, pneumonia and in people admitted to hospital for supplemental oxygen.
The device is installed on a bedside rack as a standalone unit and connected to the hospital oxygen supply. The device can also be installed on pole stands, walkers and other mobile applications. The person's oxygen saturation is measured continuously by pulse oximetry. The oxygen supply is automatically adjusted based on the person's average pulse oximetry for the last 15 seconds.
Innovations
The technology is designed to automate oxygen titration to maintain target blood oxygen saturation, helping to reduce the time the person spends in hypoxia or hyperoxia. This has the potential to improve clinical outcomes and reduce hospital bed stays. Other automatic oxygen titration devices, FreeO2 and Airvo3, are available in the UK.
Current care pathway
The British Thoracic Society's (BTS) guideline for oxygen use in healthcare and emergency settings states that pulse oximetry must be available in all locations where emergency oxygen is used, and oxygen saturation should be checked by pulse oximetry in all patients who are breathless and acutely ill.
The BTS guideline also states that all critically ill patients outside of critical care areas (intensive care units and high dependency units) should be assessed and monitored using a recognised physiological track and trigger system such as the National Early Warning Score (NEWS). Track and trigger systems are also recommended in the NICE guideline on acutely ill adults in hospital: recognising and responding to deterioration, which notes that NEWS2 (an updated version of NEWS) is endorsed by NHS England.
The BTS guideline states that oxygen therapy should be prescribed according to a target saturation range and be monitored to remain in this range. The oxygen concentration needed depends on the condition being treated.
Standard care in the NHS usually involves the person receiving a fixed dose of oxygen which is manually monitored and adjusted by healthcare professionals (nurses, doctors, intensive care team), based on pulse oximetry or arterial blood gas analysis. The track and trigger system then dictates the frequency of observations and escalation of these observations to relevant healthcare professionals. Oxygen is delivered by a nasal cannula or face mask with a predefined flow. Oxygen saturation monitoring is then repeated as needed to assess response to the oxygen flow and the flow is further adjusted accordingly.
NICE's guideline on COPD recommends oxygen therapy as a treatment option for exacerbations of COPD. People with acute respiratory distress syndrome (ARDS), including when caused by COVID‑19, may need passive oxygen therapy before further treatments such as continuous positive airway pressure (CPAP), intubation and mechanical ventilation.
The following publications have been identified as relevant to this care pathway:
Population, setting and intended user
The technology is intended for people admitted to hospital for supplemental oxygen. This may include people with respiratory conditions such as COPD, COVID‑19, asthma and pneumonia.
Various healthcare professionals may give oxygen therapy once appropriate training has been done. Staff who give oxygen should be trained across a range of devices to ensure oxygen is given safely, using appropriate devices and flow rates to achieve the target saturation.
Costs
Technology costs
The company states that the list price of O2matic PRO 100 in the UK will be between £5,000 and £7,000 dependent on volume discounts. The expected lifespan of O2matic PRO 100 is 5 years. The company release a new software update annually and improve the algorithm and new functions based on customer feedback at no extra cost. According to the company, no maintenance and calibration is needed. In cases where there is no access to a mains power source, the device will need a battery replacement at an additional £70 every 2 years. The company states that there are no additional consumable costs related specifically to the use of this technology. According to the company, the device is supplied with a reusable pulse oximeter. Any other add-on consumables are similar to current standard of care.
The company states that training is needed to use the device. The company provides initial training at no extra cost. The company provides free online material such as training videos and webinars. An extra cost is charged to the purchaser for additional face to face training.
Costs of standard care
Various SpO2 monitors are available ranging in price from £144 to £450, with separate sensors varying in price from £42 to £225.
The cost of FreeO2, another automatic system with an expected lifespan of 5 years, is £9,600 per unit (excluding VAT) with a yearly preventive maintenance and calibration cost of £450.
Resource consequences
The O2matic PRO 100 is currently used in 1 NHS Trust, the Royal Free London NHS Foundation Trust, since 2019.
Using O2matic PRO 100 in the NHS would incur an additional cost compared with standard manual delivery of oxygen. Assuming reliable SpO2 measurements and adjustments are produced, this may be offset if the claimed benefits of reduced morbidities and length of hospital stay are seen. Automated titration may also free up nurse time because it could reduce the need for manual adjustments. There is limited published evidence to support these claimed benefits.