Do ambulance paramedics administer too much oxygen to patients with acute exacerbations of chronic obstructive airways disease?

Chow, Joanna Wai Yinn; Khullar, Keshav; Katechia, Kashyap; Klim, Sharon; Kelly, Anne‐Maree

doi:10.1111/1742-6723.12391

Cited by 3 publications

(8 citation statements)

References 3 publications

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“…In an emergency, established practice may be difficult to change and oxygen administration is one of few treatment options that junior‐grade ambulance staff (emergency medical technicians) have in New Zealand. In an emergency, provision of oxygen may be thought by healthcare professionals to relieve dyspnoea regardless of oxygen saturation . In the prehospital environment it may also be difficult to diagnose patients with COPD if no prior information is available, and patients may misdiagnose themselves as having asthma .…”

Section: Discussionmentioning

confidence: 53%

“…In an emergency, provision of oxygen may be thought by healthcare professionals to relieve dyspnoea regardless of oxygen saturation. [3][4][5][6]8,10,11,13 In the prehospital environment it may also be difficult to diagnose patients with COPD if no prior information is available, and patients may misdiagnose themselves as having asthma. 5,10,15 It is unlikely that ambulance staff will see the effects of hyperoxia and resultant hypercarbia when transfer times are short.…”

Section: Discussionmentioning

confidence: 99%

“…Ambulance services are often the first point of medical care for patients with AECOPD and as the equipment carried is limited, they have traditionally relied on oxygen to drive nebuliser therapy. High flow oxygen is administered to 37–80% of patients with AECOPD in the prehospital setting and failure to adhere to recommended guidelines frequently results in over‐oxygenation . Prolonged transfers increase this risk …”

Section: Introductionmentioning

confidence: 99%

“…6 Other studies have shown a reduced risk of adverse outcomes in patients with AECOPD presenting to hospital with normoxia (PaO 2 60-100 mmHg) compared to hypoxia or hyperoxia. 4,8,9 Ambulance services are often the first point of medical care for patients with AECOPD and as the equipment carried is limited, 5,6,[9][10][11][12][13] they have traditionally relied on oxygen to drive nebuliser therapy. High flow oxygen is administered to 37-80% of patients with AECOPD in the prehospital setting 4,6,9 and failure to adhere to recommended guidelines frequently results in overoxygenation.…”

Section: Introductionmentioning

confidence: 99%

“…High flow oxygen is administered to 37-80% of patients with AECOPD in the prehospital setting 4,6,9 and failure to adhere to recommended guidelines frequently results in overoxygenation. [4][5][6][9][10][11][12][13][14][15][16][17] Prolonged transfers increase this risk. 16,18,19 Techniques intended to avoid prehospital hypercapnia have included education programmes to reduce the delivery of high flow oxygen and titration of oxygendriven nebuliser use.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

An audit of change in clinical practice: from oxygen‐driven to air‐driven nebulisers for prehospital patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

Heys

Swain

Knowles

et al. 2018

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An audit of change in clinical practice: from oxygen‐driven to air‐driven nebulisers for prehospital patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

Heys

Swain

Knowles

et al. 2018

Internal Medicine Journal

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Most impactful predictors for hyperoxaemia in exacerbation of chronic obstructive pulmonary disease managed by Emergency Medical Services and Emergency Department

Lim

Cheah

Goh

et al. 2019

Clinical Respiratory J

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Introduction:Hyperoxemia in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) leads to adverse outcomes. It remains prevalent in the pre-hospital Emergency Medical Services (EMS) and Emergency Department (ED). Objective: To determine the key predictors for hyperoxemia in AECOPD in EMS and ED. Methods: This was a prospective observational study of AECOPD patients in EMS and two EDs. Hyperoxemia was defined as PaO 2 > 65 mm Hg (corresponds to SpO 2 > 92%). We determined apriori candidate factors in Patient, Organization and Staff domains. Primary outcomes were the key predictors for hyperoxemia. Secondary outcomes were in-hospital mortality and mechanical ventilation rates in hyperoxemic versus non-hyperoxemic groups. We generated a logistic regression model for each domain. We reported the adjusted odds ratios (AORs), 95% CIs and p values.We selected the output factors using AOR ≥2.0 and ≥2.5 for modifiable and nonmodifiable factors, respectively. These selected factors were fed into a final model with eventual factors selected based on: threshold AORs as stated above and/or 95% CIs including these AORs. Results: Three hundred and twenty-six patients were analysed; 60.7% had hyperoxemia. We found three eventual modifiable factors; first, ED SpO 2 > 95% [AOR 2.62 (95% CIs: 1.61-4.33); P < 0.001], EMS non-rebreathing mask [AOR 2.01 (95% CIs:1.06-3.97); P = 0.04]; and ED nasal cannula [AOR 1.69 (95% CIs: 1.05-2.72); P = 0.03]. Secondary outcomes did not differ between groups. Conclusion: We identified three key modifiable predictors. We intend to conduct an interventional study using them to reduce hyperoxemia rate in AECOPD. K E Y W O R D SCOPD, exacerbation, hyperoxaemia, predictors | 257 LIM et aL.

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Acute oxygen therapy: a review of prescribing and delivery practices

Cousins

Wark

McDonald

2016

COPD

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Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care.

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Do ambulance paramedics administer too much oxygen to patients with acute exacerbations of chronic obstructive airways disease?

Cited by 3 publications

References 3 publications

An audit of change in clinical practice: from oxygen‐driven to air‐driven nebulisers for prehospital patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

An audit of change in clinical practice: from oxygen‐driven to air‐driven nebulisers for prehospital patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)

Most impactful predictors for hyperoxaemia in exacerbation of chronic obstructive pulmonary disease managed by Emergency Medical Services and Emergency Department

Acute oxygen therapy: a review of prescribing and delivery practices

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