Descriptive analysis of emergency department oxygen use in acute exacerbation of chronic obstructive pulmonary disease

Considine, Julie; Botti, Mari; Thomas, Samantha

doi:10.1111/j.1445-5994.2010.02220.x

Cited by 5 publications

(5 citation statements)

References 41 publications

(95 reference statements)

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“…This is likely due to an entrenched culture of health professionals to administer high concentration oxygen to breathless patients with exacerbations of COPD even when this is not recommended by evidence-based guidelines. This culture is not limited to ambulance paramedics and also occurs with hospitalbased medical and nursing staff [38][39][40]49,50,60,61]. It will require major integrated educational and management initiatives to change the practice, so that those who administer oxygen recognise that oxygen is a drug that is prescribed for defined indications, in which its benefits outweigh its risks, that prescriptions specify the dose and method of delivery to achieve a specified SpO 2 target to avoid both hypoxaemia and hyperoxaemia, and that the patients' response to oxygen therapy is monitored.…”

Section: Changing Clinical Practicementioning

confidence: 99%

Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

Pilcher

Weatherall

Perrin

et al. 2015

Expert Review of Respiratory Medicine

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During the last decade, there have been major advances in knowledge of the effects of oxygen therapy in patients with acute exacerbations of chronic obstructive pulmonary disease. This includes a randomised controlled trial of oxygen therapy in the pre-hospital setting, which showed that high concentration oxygen therapy leads to a 2.4-fold increased risk of mortality compared with titrated oxygen therapy to maintain oxygen saturations (SpO2) within a target range of 88-92%. Professional guidelines now recommend the use of supplementary oxygen in acute exacerbations of chronic obstructive pulmonary disease only if the SpO2 is less than 88%, with titration to achieve an SpO2 of 88-92%, and the delivery of bronchodilators by air-driven nebulisation or metered dose inhaler with a spacer. The aim of this review is to provide an overview of the evidence base that underpins these recommendations. We suggest that their implementation will require important changes to current clinical practice in which there is an entrenched culture of the use of high concentration oxygen therapy.

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Section: Changing Clinical Practicementioning

confidence: 99%

Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

Pilcher

Weatherall

Perrin

et al. 2015

Expert Review of Respiratory Medicine

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“…There is evidence to suggest that paramedical services and hospital emergency personnel routinely apply O 2 to patients with significant illness 13,14 and there may be significant variation in the O 2 management of emergency department patients with such diseases as chronic obstructive pulmonary disease 15 . As ICU patients may be transported and/or admitted to ICU with higher oxygenation targets that are subsequently titrated down as required over the first few hours after admission, strict study guidelines were in place in order that data collected for use in the study reflected only ICU practice.…”

Section: Data Collection Processmentioning

confidence: 99%

A Snapshot of the Oxygenation of Mechanically Ventilated Patients in One Australian Intensive Care Unit

Dennis

Torre

Baker

et al. 2017

Anaesth Intensive Care

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Hyperoxaemia in patients undergoing mechanical ventilation (MV) has been found to be an independent predictor of worse outcome and in-hospital mortality in some conditions. Data suggests that a fraction of inspired oxygen (FiO 2 ) of 0.4 or lower may produce hyperoxaemia although it is commonly accepted without adjustment in ventilator settings. The primary aim of this study was to observe current practice at one Australian tertiary intensive care unit (ICU) with regard to prescription and titration of oxygen (O 2 ) in patients undergoing MV, in particular whether they received higher FiO 2 than required according to arterial blood gas (ABG) results, and whether there was FiO 2 titration as a response to initial ABG results during the 12 hours following. A retrospective observational study of 151 ICU patients undergoing MV between November 2013 and February 2014 was conducted, with ABGs as the primary outcome measure. There were 250 ABG measures, with mean FiO 2 0.38 (range 0.3-1.0) and mean PaO 2 114 mmHg (standard deviation 36). Over all observations, 197 (79%) were of FiO 2 ≤0.4, however no patients were ventilated on room air (FiO 2 0.21) and 114 (46%) were in the hyperoxaemic range. Oxygen titration (up or down) occurred in 31% of patients. Morning ABGs were taken at a time suggested by ICU guidelines, and on review of these measures, the mean FiO 2 was lower than that purported to create toxicity. Subsequently, almost one-third of the cohort had their FiO 2 titrated, however there was a floor effect whereby 39%-43% of the cohort received an FiO 2 of 0.3.

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“…These approaches range from smoking cessation programs to, nutritional intervention, psychosocial support and in some cases surgical interventions. 16 A group of respiratory rehabilitation techniques such as hypoxic training/oxygen supplementation, 17 –20 noninvasive mechanical ventilation (NIMV), 5,21 –23 aerobic exercises, 24,25 and controlled breathing techniques 8,26 –28 are also employed for a variety of important outcomes for patients with COPD. While the effect of these respiratory rehabilitation techniques on most COPD symptoms is clear, the evidence to support their effects on the AF outcomes is nonexistent.…”

Section: Introductionmentioning

confidence: 99%

Effect of respiratory rehabilitation techniques on the autonomic function in patients with chronic obstructive pulmonary disease: A systematic review

2016

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Patients with chronic obstructive pulmonary disease (COPD) show several extrapulmonary abnormalities such as impairment in the autonomic function (AF). Similarly, the use of respiratory training techniques such as controlled breathing techniques, noninvasive mechanical ventilation (NIMV), and oxygen supplementation for AF modulation in patients with COPD is popular in existing literature. However, the evidence to support their use is nonexistent. A systematic search of studies reporting on the effect of controlled breathing techniques, NIMV, and/or oxygen supplementation techniques on AF outcome parameters was conducted in three online databases: PubMed, Embase, and Web of Science. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, relevant studies were retained and qualitatively analyzed for evidence synthesis. The methodological quality in these studies was evaluated using the evidence based guideline development (EBRO) checklists per designs provided by the Dutch Cochrane Centre. Eighteen studies met the inclusion criteria of the review and were included and discussed. The evidence synthesis revealed that a strong and moderate level evidence supported oxygen supplementation and slow breathing techniques, respectively, in significantly enhancing the baroreceptor sensitivity (BRS) values in patients with COPD. The effect of the examined techniques on the heart rate variability and muscle sympathetic nerve activity was of a limited or inconsistent evidence. The findings from this review suggest that oxygen supplementation and controlled breathing techniques have profound positive influence on the BRS in patients with COPD. However, it is not fully clear whether these influence translates to any therapeutic benefit on the general AF of patients with COPD in the long term.

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Descriptive analysis of emergency department oxygen use in acute exacerbation of chronic obstructive pulmonary disease

Cited by 5 publications

References 41 publications

Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

A Snapshot of the Oxygenation of Mechanically Ventilated Patients in One Australian Intensive Care Unit

Effect of respiratory rehabilitation techniques on the autonomic function in patients with chronic obstructive pulmonary disease: A systematic review

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