This multicenter RCT (4 US hospitals, May 2024–Nov 2025) enrolled 300 acutely ill adults receiving supplemental oxygen and compared autonomous (closed-loop) oxygen titration vs. usual manual clinician titration over the first 72 hours, targeting SpO₂ 90–96%.
Autonomous titration increased time in the normoxemia range vs. usual care (85% vs. 63%; adjusted RD +21 pp; 95% CI 18–25 pp; P<.001) and reduced time in hypoxemia (SpO₂ <88%: 2.0% vs. 3.6%; adjusted RD −1.3 pp; 95% CI −2.0 to −0.5 pp; P=.002). Hyperoxemia time was also markedly lower (9.2% vs. 29.1%).
- Trial was unblinded, which may have influenced usual-care clinician behavior. - The 72-hour observation window limits insight into longer-term clinical outcomes (e.g., mortality, ventilator-free days). - Full-text was not accessible; safety events and adverse outcomes are not reported here.
Autonomous oxygen titration devices substantially outperform intermittent manual adjustments at keeping acutely ill patients in a safe SpO₂ range — cutting hyperoxemia exposure by two-thirds. Clinicians managing hospitalized patients on supplemental oxygen should consider closed-loop titration systems where available.
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