Emergency oxygen therapy for the breathless patient. Guidelines prepared by North West Oxygen Group

Abstract

Based on a systematic review of the scientific literature, the North West Oxygen Group have developed guidelines for oxygen therapy for patients who present with acute breathlessness. The above emergency medicine physicians, chest physicians and intensive care physicians have gained approval from their regional societies to have this document accepted as the agreed regional guidelines for the use of oxygen in the immediate care of breathless patients in the North West of England. Flow charts are also currently being developed, based on these guidelines, for use by ambulance and emergency department staV in the area. It is recognised that the present use of oxygen across these specialties is inconsistent. This protocol will help us to deliver standardised oxygen therapy to breathless patients by paramedics, doctors and nurses. This will also improve the consistency of medical training across these disciplines in the North West.

The use of oxygen in acute exacerbations of chronic obstructive pulmonary disease: a prospective audit of pre-hospital and hospital emergency management

“…Murphy et al review the dangers of HFO in AECOPD showing evidence that the resultant hypercapnoea was associated with coma and death, 2 and their concerns are reflected in the guidelines produced by North West Oxygen Group (NWOG). 3 Howard and Harrison report similar findings in their prospective study in East Anglia (personal communication) identifying 27 episodes of hypercapnoea associated with HFO and hypoxia out of 175 admissions with AECOPD. The practice of liberal and unlimited oxygen administration to patients in the period leading to hospital admission in those with AECOPD is widespread and may cause additional morbidity and mortality.…”

“…In a recent small, prospective, randomised study 3 in which oxygen therapy was titrated to either a low (6.6-9 kPa) or high ( 9 kPa) arterial PO 2 , the only deaths or deteriorations requiring mechanical ventilation were in the low PaO 2 group.…”

Hypercapnia and oxygen therapy in older asthmatic patients

“…The effect of chronic hypercarbia on respiratory drive in asthma is not known, unlike in COPD, in which acute-onchronic and chronic hypercapnia dampens the hypoxic respiratory drive [2,3,5,[13][14][15]19]. Unrestricted oxygen administration in a COPD patient with chronic hypercapnia leads to centrally mediated alveolar hypoventilation, reduced hypoxic drive, and worsening respiratory acidosis [3,10,13,20].…”

“…Respiratory acidosis and hypercapnia during acute exacerbation of asthma and COPD leads to neurological and cardiorespiratory dysfunction, such as altered consciousness, tachycardia and hypertension [2][3][4]. These clinical manifestations are associated with increased mortality [5].…”

Emergency oxygen use in adult patients: concise guidance

“…5 Against this background the Standards of Care Committee of the British Thoracic Society (BTS) established a working party in association with 21 other societies and royal colleges to produce an evidence-based and up-to-date guideline for emergency oxygen use in the UK. Information in this concise guidance document has been extracted from the full BTS guideline.…”