FreeO2 automatic oxygen titration for chronic obstructive pulmonary disease and respiratory distress syndrome

Level of innovation

All 3 experts described the technology to be novel with uncertain safety and efficacy. Two experts said that the technology cannot replace standard care, but that it could be used alongside standard care and may be a useful addition in some settings and individuals. All experts said that they were not aware of any alternative technologies for this function.

Potential patient impact

Two experts reported that the device could reduce patient risk and morbidity from oxygen toxicity. Both agreed that it could assist in weaning O₂ for patients with complex needs, potentially resulting in reduced length of hospital stay. One expert highlighted the potential to reduce medical error with the use of this device.

All experts described people with chronic obstructive pulmonary disease (COPD) as a subgroup who may particularly benefit from this technology, alongside people needing supplemental oxygen with viral pneumonias such as COVID‑19.

Potential system impact

Experts said the device could reduce length of stays and improve hyperoxia outcomes and oxygen use. More specifically 1 expert stated that it could reduce the length of stay in people with acute exacerbations of COPD because of improved weaning of oxygen supplementation.

All experts agreed that the technology would cost more than standard care and the cost benefits were not clear. One expert did raise the potential for reduced nursing time needed from using the technology. Experts raised several aspects around the costs that would need to be better understood, including the costs associated with consumables, maintenance, servicing, software updates and training. All experts said that additional training would be needed with the device to ensure its safe use.

Experts highlighted implementation considerations for the technology. One expert raised the connectivity of the device to monitors needing either Bluetooth or 9‑pin connectors and the significant capital investment that would be needed for Bluetooth monitors.

General comments

Experts listed a number of potential risks for harm with the device. One expert discussed the theoretical risk of machine failure, and theoretical risk of death from hypoxia if the machine failed, as well as risk of signal loss and software failure. Another expert stated that the lack of applicability of the procedure in people who are haemodynamically compromised and people with poor peripheral circulation that would need facilities for manual oxygen titration to be available in parallel. One expert highlighted that the evidence base includes predominantly single-centre studies, or short durations which may not capture adverse events.

Experts highlighted several evidence gaps that would be beneficial to address. One expert queried if the increased time spent in target saturation showed significant changes to hard clinical outcomes (such as mortality, length of stay and readmission rates). Two experts voiced a need for in depth economic analysis to show the cost benefits. Another expert highlighted the gap in evidence for its use in people with respiratory distress syndrome.