Manual compared to automated closed-loop oxygen control strategies in hospitalised adults: a systematic review and meta-analysis
In brief
Automated oxygen control adds 21 percentage points of time in target
Across seven randomized trials involving 635 hospitalized adults, automated closed-loop control increased time within the target oxygen saturation range by an average of 21.2 percentage points versus manual adjustment. The advantage was larger with low-flow oxygen than with high-flow nasal oxygen, and the studies varied considerably, so the benefit may depend on how oxygen is delivered.
- Journal
- European respiratory review : an official journal of the European Respiratory Society (Q1)
- Published
- 7 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Louis Kirton, Rowan Biggs, Neakiry Kivi, Francesca Lynch, Tanira Kingi, Ross Sayers, et al.
- PMID
- 42843846
- DOI
- 10.1183/16000617.0167-2026
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (paper of the day, 8 October 2026).
Abstract
BACKGROUND: Closed-loop oxygen control (CLOC) systems improve accuracy of oxygen delivery compared with standard manual oxygen adjustment. Determination of their efficacy in delivering oxygen noninvasively to adults, using different delivery methods and across different hospital locations, would enhance clinical practice. METHODS: We conducted a systematic review and meta-analysis, searching Medline, Embase, Scopus Basic and Advanced, and Cochrane databases. Randomised controlled trials comparing time spent within a target peripheral oxygen saturation (S pO2 ) range between CLOC and manual oxygen control in hospitalised adults (>18 years) were included. Outpatient studies and studies using mechanical ventilation were excluded. The primary outcome was proportion of time spent within a target S pO2 range. Meta-regression was performed for pre-determined study-level covariates, including oxygen delivery mode and locations of care. RESULTS: The search identified 3777 papers; of these, seven were included, with 635 participants. The mean proportion of time spent within the target S pO2 range was between 81.2 and 94.9% for CLOC and 51.3-84.0% for manual oxygen control. The mean difference was 21.2% (95% CI 18.5-23.8, p<0.0001), favouring CLOC. Evidence of heterogeneity (I2=87.9) was explained by three studies using low-flow oxygen therapy, mean difference 30.9% (95% CI 27.0-34.8, p<0.0001); compared with four studies using high-flow nasal oxygen therapy, mean difference 12.7% (95% CI 9.1-16.4, p<0.001). CONCLUSIONS: CLOC improves adherence to a target S pO2 range compared to manual oxygen control and is an effective approach for achieving a target S pO2 range when delivering oxygen noninvasively in hospitalised adults.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.