The edition · Internal Medicine
Software-titrated oxygen kept ward patients in range far longer; no consistent malformation signal for first-trimester benzodiazepines
A four-hospital trial of autonomous oxygen titration, a veterans cohort comparing nine liver risk scores, a long COVID fatigue trial of fluvoxamine, and a large claims analysis for counselling women who took benzodiazepines early in pregnancy.
The edition in brief
SAVE-O2 randomised 300 hospitalised adults on supplemental oxygen at four US hospitals to autonomous titration or manual titration for 72 hours. Time in the target saturation range of 90% to 96% was 85% vs 63% (adjusted difference 21 percentage points, 95% CI 18 to 25), with less time in hypoxaemia (2.0% vs 3.6%) and in hyperoxaemia (9.2% vs 29.1%). No clinical outcomes were reported. A Veterans Affairs cohort of 853,131 adults with steatotic liver disease compared nine risk scores; FIB-4, APRI and SAFE discriminated cirrhosis best, SAFE gave the greatest net benefit, and no score was useful for deciding on hepatocellular carcinoma screening in non-cirrhotic disease. A Brazilian adaptive trial of 399 adults with long COVID fatigue found fluvoxamine 100 mg twice daily improved fatigue scores by 0.43 points at day 60 and 0.58 at day 90 against placebo; metformin was inconclusive after a dose change. A pooled analysis of about 4.2 million US pregnancies found no consistent increase in major congenital malformations with first-trimester benzodiazepine fills (pooled adjusted RR 0.99, 95% CI 0.96 to 1.03).
Autonomous oxygen titration kept ward patients in range far more of the time
Write an explicit saturation target range for every patient on oxygen and review it often, because manual titration leaves much time out of range.
FIB-4, APRI and SAFE predicted cirrhosis best; none helped decide on liver cancer screening
Use a fibrosis score such as FIB-4 to decide who needs further liver assessment, and do not use it to start cancer surveillance.
Fluvoxamine modestly reduced long COVID fatigue; metformin was inconclusive
Fluvoxamine is worth discussing for persistent post-COVID fatigue only after checking drug interactions, with the modest size of benefit made clear.
Write the oxygen target on the chart
Prescribe a saturation target for every patient on oxygen and turn it down when they are above it.
First-trimester benzodiazepine fills showed no consistent rise in malformations
When counselling after first-trimester benzodiazepine exposure, explain that a large population analysis found no consistent malformation excess, and review the need for the drug rather than stopping it suddenly.
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