New Zealand Leads Medical Breakthrough In Oxygen Therapy

Fisher & Paykel Healthcare’s new Airvo™ 3 device with OptiO2™ technology, with support from Medical Research Institute of New Zealand, offers a major breakthrough in the delivery of oxygen therapy to critically ill patients.

Landmark clinical research, undertaken by the Medical Research Institute of New Zealand (MRINZ), has shown that automatically measuring and adjusting the delivery of oxygen (known as titration) to achieve a pre-set level of oxygen in the blood of seriously ill patients, results in a far more precise delivery of oxygen than the current standard clinical practice of manual titration.

Fisher & Paykel Healthcare applied this research in the development of its new Airvo 3 device, progressed through an ongoing partnership with research teams at MRINZ. Designed to deliver Optiflow™ therapy, the device incorporates Fisher & Paykel Healthcare’s OptiO2 closed-loop system for targeted oxygen delivery. A controlled market release of the Airvo 3 with OptiO2 technology is now underway in Aotearoa New Zealand, and it will be available in other markets as regulatory clearances are received.

The ‘Automatic versus manual oxygen titration using a novel nasal high-flow device in medical inpatients with an acute illness’ study, published in the British Medical Journal Open Respiratory Research in 2021, represents the latest in a longstanding programme of work at the MRINZ which has determined how best to administer oxygen therapy.

MRINZ has assessed both the risk and benefits of different oxygen regimens in a wide range of acute and chronic medical conditions through a series of randomised controlled trials, and used this knowledge to guide clinical practice.

Earlier trial outcomes showing that both too much and too little prescribed oxygen has potential risks was crucial in the development of international guidelines for adopting the ‘swimming between the flags’ oxygen delivery framework. ‘Swimming between the flags’ is a treatment concept promoted by respiratory specialist Professor Richard Beasley, Director of the MRINZ. This concept, now used worldwide, simplifies how clinicians administer oxygen therapy to critically ill patients, giving patients as much or little oxygen as needed to keep their blood oxygen saturation within a prescribed target range.

In current clinical practice health professionals attempt to achieve a pre-set target of blood oxygen levels by measuring oxygen saturations with a pulse oximeter, a small device clipped to a patient’s finger, and then manually varying the amount of oxygen administered in an attempt to achieve the target oxygen saturation range. This practice can be inadequate, because even with close monitoring patients may be below or above the target range for prolonged periods of time.

To overcome this problem, Fisher & Paykel Healthcare have enhanced the Airvo 3 device, allowing humidified oxygen to be automatically titrated in response to changes in oxygen saturation, as measured from the pulse oximeter linked to the Airvo system.

Professor Richard Beasley, MRINZ Director, says, “Fisher & Paykel Healthcare’s Airvo 3 is likely to result in a paradigm change in the way oxygen is delivered to critically ill patients here in Aotearoa New Zealand, and eventually, globally. With this new device there is now the capability to titrate the amount of oxygen delivered via nasal high flow therapy, which may help to ensure that the patient can safely ‘swim between the flags’.”

Oxygen is a common treatment in patients who are admitted to hospital acutely unwell. This latest MRINZ clinical research, sponsored by Fisher & Paykel Healthcare, studied acutely unwell patients admitted to Wellington Regional Hospital. The patients had a wide range of medical conditions including heart failure, pneumonia, pulmonary embolism and exacerbations of asthma and chronic obstructive pulmonary disease (COPD).

The study found that automatic oxygen titration resulted in 96% of the time spent within the target saturation range, compared with 71% with manual titration.

Dr James Harper, lead researcher in the study, says, “These findings are really important, as they show that use of this new device ensures that unwell patients spend almost all the time precisely within the optimum target saturation range, avoiding the risk of both too much and too little oxygen.”

“As we know that maintaining oxygen saturations within prescribed target ranges leads to improved clinical outcomes, the use of this device is likely to help many patients who need oxygen in hospital,” says Dr Harper.

Garry Middleton Simpson is one of the twenty patients who took part in the study. “As a patient you take for granted that the oxygen that is administrated to you is being delivered the best possible way. I am incredibly grateful that the researchers at MRINZ and the team at Fisher & Paykel Healthcare are so curious and dedicated, questioning clinical methods, and finding new and better ways to care for sick people when they need it most,” says Garry.

Quality medical care increasingly relies on innovative new technologies, and the MRINZ collaboration with Fisher & Paykel Healthcare represents a significant and valued partnership. The MRINZ works closely with the biomedical industry to design and conduct gold-standard research supporting device development and adoption in practice.

“Medical devices and advanced technologies greatly help clinicians deliver the best possible patient care. Supporting product innovation and development is a significant part of our MRINZ focus. It’s a privilege to work in collaboration with Fisher & Paykel Healthcare’s world-leading designers and engineers to develop and test novel devices that have the potential to change clinical practice,” says Adjunct Professor Alex Semprini, MRINZ Deputy Director.

Andrew Somervell, VP – Products and Technology at Fisher & Paykel Healthcare, says, “Our teams worked closely with our customers and clinicians to design a device that meets healthcare providers’ evolving needs and delivers better patient outcomes. We value our longstanding relationship with MRINZ and are grateful for their support on the research and development of the Airvo 3”.

ENDS

BACKGROUND DETAIL

https://www.fphcare.com/nz/corporate/investor/news/fy22/fph-unveils-airvo-3/

‘Automatic versus manual oxygen titration using a novel nasal high-flow device in medical inpatients with an acute illness’: https://bmjopenrespres.bmj.com/content/8/1/e000843 
 

Current guideline recommendations state oxygen should be administered to acutely unwell patients to achieve a target oxygen saturation (SpO2) range. The current practice of manual oxygen titration frequently results in SpO2 outside of a prescribed range. The aim of this study was to assess the efficacy of automatic oxygen titration using a closed-loop feedback system to achieve SpO2 within a prescribed target range.

An open-label randomised parallel group trial was undertaken comparing automatic oxygen titration using a novel nasal high-flow device to manual oxygen titration using nasal high flow. Medical inpatients requiring oxygen therapy in Wellington Regional Hospital, New Zealand with a prescribed target SpO2 range of 88%-92% or 92%-96% were recruited and randomised equally between the interventions for a period of 24 hours. The primary outcome was the proportion of time spent with SpO2 within the prescribed range.

Twenty patients were included in the analysis. Automatic oxygen titration resulted in a median (IQR) 96.2% (95.2-97.8) of time within the target range compared with 71% (59.4-88.3) with manual titration; difference (95% CI) 24.2% (7.9% to 35%), p<0.001.

The conclusion of the study is that nasal high-flow with automatic oxygen titration resulted in a greater proportion of time spent with SpO2 in target range compared with manual titration.

Medical Research Institute of New Zealand
Rangahautia Te Ora

The Medical Research Institute of New Zealand (MRINZ) is Aotearoa New Zealand’s leading independent medical research institute. MRINZ research is guided by a simple philosophy: it must challenge dogma, increase knowledge, and have the potential to improve clinical practice and outcomes, both in Aotearoa New Zealand, and internationally.

The MRINZ’s research teams are dedicated to investigating important public health problems, delivering high quality evidence on which to improve the management of disease and patient care. An internationally recognised academic institution, the MRINZ is a charitable trust pursuing advances in clinical practice and providing a base for specialist training in medical research. The MRINZ is committed to contributing toward a more equitable society that celebrates Te Ao Māori and upholds Te Tiriti o Waitangi. 
 

Fisher & Paykel Healthcare

Fisher & Paykel Healthcare is a leading designer, manufacturer and marketer of products and systems for use in acute and chronic respiratory care, surgery and the treatment of obstructive sleep apnea. The company’s products are sold in over 120 countries worldwide. For more information, visit www.fphcare.com.

Dr James Harper, MRINZ Clinical Research Fellow and Alumni
James completed his undergraduate medical training at the University of Bristol, England and graduated with honours in 2009. He subsequently completed his postgraduate medical training in the South-West of England, specialising in Respiratory Medicine. James undertook a PhD during his specialist Respiratory training at the Medical Research Institute of New Zealand during which time he investigated a novel method of oxygen delivery involving nasal high-flow with automatic oxygen titration. He was successfully awarded a PhD from Victoria University of Wellington in 2021 and subsequently returned to the UK to complete his specialist training. James has recently been appointed a Consultant in Respiratory Physician at the Royal United Hospital, Bath. James has an ongoing interest in research and oxygen delivery for unwell patients.
 

Professor Richard Beasley, MRINZ Director
Richard Beasley, MBChB, MD, DSc, CNZM, is a physician at Wellington Regional Hospital, Director of the Medical Research Institute of New Zealand, and Professor of Medicine at Victoria University of Wellington. He is an Adjunct Professor at the University of Otago and Visiting Professor, University of Southampton, United Kingdom. He was previously the Deputy Chair of the Health Research Council of New Zealand. Richard’s areas of expertise and medical interest include Asthma, Chronic Obstructive Pulmonary Disease, Epidemiology, Oxygen and Respiratory Medicine.

Professor Beasley is available for interview.

MEDIA ENQURIES

Nicola Marshall, MRINZ Communications Advisor
Nicola.Marshall@mrinz.ac.nz
+64 21 256 4737

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