***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Oxygen is commonly administered to patients with ST-elevation – myocardial infa rct ion despite previous studies suggesting a possible increase in myocardial injury as a result of coronary vasoconstriction and heightened oxidative stress . Methods and Results — We conducted a multicenter , prospect i ve , r and omized , controlled trial comparing oxygen ( 8 L/min ) with no supplemental oxygen in patients with ST-elevation – myocardial infa rct ion diagnosed on paramedic 12-lead ECG . Of 638 patients r and omized , 441 patients had confirmed ST-elevation – myocardial infa rct ion and underwent primary end-point analysis . The primary end point was myocardial infa rct size as assessed by cardiac enzymes , troponin I , and creatine kinase . Secondary end points included recurrent myocardial infa rct ion , cardiac arrhythmia , and myocardial infa rct size assessed by cardiac magnetic resonance imaging at 6 months . Mean peak troponin was similar in the oxygen and no oxygen groups ( 57.4 versus 48.0 & mgr;g/L ; ratio , 1.20 ; 95 % confidence interval , 0.92–1.56 ; P=0.18 ) . There was a significant increase in mean peak creatine kinase in the oxygen group compared with the no oxygen group ( 1948 versus 1543 U/L ; means ratio , 1.27 ; 95 % confidence interval , 1.04–1.52 ; P=0.01 ) . There was an increase in the rate of recurrent myocardial infa rct ion in the oxygen group compared with the no oxygen group ( 5.5 % versus 0.9 % ; P=0.006 ) and an increase in frequency of cardiac arrhythmia ( 40.4 % versus 31.4 % ; P=0.05 ) . At 6 months , the oxygen group had an increase in myocardial infa rct size on cardiac magnetic resonance ( n=139 ; 20.3 versus 13.1 g ; P=0.04 ) . Conclusion — Supplemental oxygen therapy in patients with ST-elevation – myocardial infa rct ion but without hypoxia may increase early myocardial injury and was associated with larger myocardial infa rct size assessed at 6 months . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01272713 BACKGROUND : One century after the introduction of the oxygen flow meter into clinical practice , we have developed a device , FreeO2 , that automatically titrates the oxygen flow delivered to spontaneously breathing patients , with the aim of maintaining a stable SpO2 . We evaluated this system in healthy subjects during induced hypoxemia . METHODS : Hypoxemia was induced in 10 healthy subjects while breathing a gas mixture of variable FIO2 ( air + nitrogen ) . Each subject performed 3 hypoxemic challenges with the addition , in a r and om order , of either : air with constant flow ( 1.5 L/min ) ; oxygen with constant flow ( 1.5 L/min ) ; or automatic oxygen flow titration . Subjects were blinded to the intervention .  Oxygen flow , SpO2 , end-tidal CO2 , respiratory rate , and heart rate were recorded every second . The primary outcome was the time with SpO2 between 92 % and 96 % . RESULTS : The SpO2 target ( 92–96 % ) was achieved a median of 26.0 % , 36.8 % , and 66.5 % ( P < .001 ) of the time with air , constant oxygen , and automated oxygen titration , respectively . Severe oxygen desaturations ( SpO2 < 88 % ) were respectively observed at a median of 33.7 % , 12.7 % , and 0.4 % of the time ( P < .001 ) . Hyperoxia was present a median of 4.1 % , 39.1 % , and 14.5 % of the time ( P < .001 ) . Tachycardia was present with air and with constant oxygen flow , but not while using automated oxygen titration . These results were obtained with a mean and maximal oxygen flow of 1.3 L/min and 7.6 L/min with the automated titration . CONCLUSIONS : In this model of induced hypoxemia , the FreeO2 system that automatically titrates the oxygen flow was more efficient at maintaining the SpO2 target , while ensuring a statistically significant reduction in the rates of severe hypoxemia and hyperoxia , in comparison with air or constant oxygen flow . These beneficial results were obtained with less oxygen , in comparison to a constant oxygen flow In preterm infants receiving supplemental oxygen  , manual control of the inspired oxygen fraction is often time-consuming and inappropriate . We developed a system for automatic oxygen control and hypothesized that this system is more effective than routine manual oxygen control in maintaining target arterial oxygen saturation levels . We performed a r and omized controlled crossover clinical trial in 12 preterm infants receiving nasal continuous positive airway pressure and supplemental oxygen .  Periods with automatic and routine manual oxygen control were compared with periods of optimal control by a fully dedicated person . The median ( range ) percentage of time with arterial oxygen saturation levels within target range ( 87 - 96 % ) was 81.7 % ( 39.0 - 99.8 ) for routine manual oxygen control , 91.0 % ( 41.4 - 99.3 ) for optimal control , and 90.5 % ( 59.0 - 99.4 ) for automatic control ( ANOVA : p = 0.01 ) . Pairwise post hoc comparisons revealed a statistically significant difference between automatic and routine manual oxygen control ( Dunnett 's test : p = 0.02 ) . The frequency of manual oxygen adjustments was lowest in automatic control ( Friedman 's test : p < 0.001 ) . Automatic oxygen control may optimize oxygen administration to preterm infants receiving nasal continuous positive airway pressure and reduce nursing time spent with oxygen control Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Introduction We developed a device ( FreeO2 ) that automatically adjusts the oxygen flow rates based on patients ’ needs , in order to limit hyperoxia and hypoxemia and to automatically wean them from oxygen . Objective The aim of this study was to evaluate the feasibility of using FreeO2 in patients hospitalized in the respiratory ward for an acute exacerbation of COPD . Methods We conducted a r and omized controlled trial comparing FreeO2 vs manual oxygen titration in the respiratory ward of a university hospital . We measured the perception of appropriateness of oxygen titration and monitoring in both groups by nurses and attending physicians using a Likert scale . We evaluated the time in the target range of oxygen saturation ( SpO2 ) as defined for each patient by the attending physician , the time with severe desaturation ( SpO2 < 85 % ) , and the time with hyperoxia ( SpO2 > 5 % above the target ) . We also recorded length of stay , intensive care unit admissions , and readmission rate .  Fifty patients were r and omized ( 25 patients in both groups ; mean age : 72±8 years ; mean forced expiratory volume in 1 second : 1.00±0.49 L ; and mean initial O2 flow 2.0±1.0 L/min ) . Results Nurses and attending physicians felt that oxygen titration and monitoring were equally appropriate with both O2 administration systems . The percentage of time within the SpO2 target was significantly higher with FreeO2 , and the time with severe desaturation and hyperoxia was significantly reduced with FreeO2 . Time from study inclusion to hospital discharge was 5.8±4.4 days with FreeO2 and 8.4±6.0 days with usual oxygen administration ( P=0.051 ) . Conclusion FreeO2 was deemed as an appropriate oxygen administration system by nurses and physicians of a respiratory unit . This system maintained SpO2 at the target level better than did manual titration and reduced periods of desaturation and hyperoxia . Our results also suggest that FreeO2 has the potential to reduce the hospital length of stay BACKGROUND AND OBJECTIVE : In preterm infants receiving supplemental oxygen  , routine manual control ( RMC ) of the fraction of inspired oxygen ( FIO2 ) is often difficult and time consuming . We developed a system for closed-loop automatic control ( CLAC ) of the FIO2 and demonstrated its short-term safety and efficacy in a single-center study . The objective of this study was to test the hypothesis that this system is more effective than RMC alone in maintaining arterial oxygen saturation within target levels when evaluated over 24 hours under routine conditions and with different target levels . METHODS : We performed a multicenter , r and omized controlled , crossover clinical trial in 34 preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure and supplemental oxygen .  Twenty-four – hour periods with RMC were compared with 24-hour periods of RMC supported by CLAC . RESULTS : The median ( range ) percentage of time with arterial oxygen saturation levels within target range was 61.4 ( 31.5–99.5 ) for RMC and 71.2 ( 44.0–95.4 ) for CLAC ( P < .001 ) . The median ( range ) number of manual FIO2 adjustments was reduced from 77.0 ( 0.0–224.0 ) for RMC to 52.0 ( 10.0–317.0 ) for CLAC ( P = .007 ) . CONCLUSIONS : CLAC may improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload related to RMC Oxygen is commonly administered in hospitals , with poor adherence to treatment recommendations . We conducted a multicentre r and omised controlled study in patients admitted to the emergency department requiring O2 ≥3 L·min−1 . Patients were r and omised to automated closed-loop or manual O2 titration during 3 h. Patients were stratified according to arterial carbon dioxide tension ( PaCO2 ) ( hypoxaemic PaCO2≤45 mmHg ; or hypercapnic PaCO2>45–≤55 mmHg ) and study centre . Arterial oxygen saturation measured by pulse oximetry ( SpO2 ) goals were 92–96 % for hypoxaemic , or 88–92 % for hypercapnic patients . Primary outcome was % time within SpO2 target . Secondary endpoints were hypoxaemia and hyperoxia prevalence , O2 weaning , O2 duration and hospital length of stay . 187 patients were r and omised ( 93 automated , 94 manual ) and baseline characteristics were similar between the groups . Time within the SpO2 target was higher under automated titration ( 81±21 % versus 51±30 % , p<0.001 ) . Time with hypoxaemia ( 3±9 % versus 5±12 % , p=0.04 ) and hyperoxia under O2 ( 4±9 % versus 22±30 % , p<0.001 ) were lower with automated titration . O2 could be weaned at the end of the study in 14.1 % versus 4.3 % patients in the automated and manual titration group , respectively ( p<0.001 ) . O2 duration during the hospital stay was significantly reduced ( 5.6±5.4 versus 7.1±6.3 days , p=0.002 ) . Automated O2 titration in the emergency department improved oxygenation parameters and adherence to guidelines , with potential clinical benefits . Automated oxygen titration is superior to manual administration in terms of time within oxygenation targets BACKGROUND : Arterial oxygen desaturation frequently occurs in patients with COPD during daily activities at home . Oxygen flow is usually set at fixed and low rates for ambulatory patients . We evaluated an innovative closed-loop system ( FreeO2 ) that automatically adjusts the oxygen flow to the patient 's needs in subjects with COPD during walking followed by recovery time , such as during ambulatory conditions . METHODS : Patients with COPD who exhibited oxygen desaturation on exertion were included in the study . Subjects performed endurance shuttle walk tests followed by 10 min of recovery . The tests were conducted in a r and om order and in crossover with the 3 following conditions : subjects breathing ( 1 ) air at 2 L/min , ( 2 ) oxygen at 2 L/min , or ( 3 ) FreeO2 ( variable oxygen flow ) . SpO2 , pulse rate , PETCO2 , breathing frequency , and oxygen flow  were continuously recorded during the 3 conditions . The primary outcome was the percentage of time within the SpO2 target of 92–96 % . Secondary outcomes included the endurance shuttle walk test time and distance .  RESULTS : Sixteen subjects with COPD were recruited . The percentage of time with SpO2 in the target range ( 92–96 % ) was higher while using the FreeO2 , and time with severe oxygen desaturation ( SpO2 < 88 % ) was lower with FreeO2 in comparison with constant-flow oxygen and air testing conditions ( 0.6 % vs 23.9 % vs 52.2 % , P < .001 ) . In comparison with air , walking distance was increased by 35 % with oxygen ( P = .045 ) and by 63 % with FreeO2 ( P < .001 ) . The walking distance was increased by 17 % with FreeO2 
    Output:
    
We did not observe a reduction in the need for ventilatory assistance or in mortality in the automatic titration period .
Conclusions : In patients requiring supplemental oxygen in the hospital , automatic oxygen titration was associated with a reduction in length of both hospital stay and oxygen therapy , as well as a greater percentage of time spent within the saturation target range .
However , it was not associated with a significant difference in the need for mechanical ventilation or in mortality .