Emergency oxygen therapy for the COPD patient

Murphy, Ross; Driscoll, Peter; O’Driscoll, Ronan

doi:10.1136/emj.18.5.333

Cited by 69 publications

(95 citation statements)

References 42 publications

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“…Vulnerable groups include not only chronic obstructive pulmonary disease (COPD), where high concentrations of inspired oxygen are linked with increased mortality during acute exacerbation [16,17], but also severe asthma, cystic fibrosis, bronchiectasis, chest wall disorders, neuromuscular disease and obesity hypoventilation [5,18]. All at-risk patients need to be identified when prescribing and administering oxygen.…”

Section: Statement Of Interestmentioning

confidence: 99%

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Emergency oxygen therapy: from guideline to implementation

Kane

Decalmer

O’Driscoll

2013

Breathe

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Educational aimsTo help readers understand the best way to use oxygen when they care for patients with medical emergencies.To encourage best practice in the use of emergency oxygen therapy.To raise awareness of the British Thoracic Society (BTS) guideline for emergency oxygen use.SummaryOxygen is the most commonly used drug in emergency medicine and when used judiciously in the treatment of hypoxaemia it undoubtedly saves life. However, oxygen is often used inappropriately and the dangers of over-oxygenation are unappreciated.In 2008, the first formal guidance on emergency oxygen use was produced by the British Thoracic Society. The guideline is objective, evidence based and peer reviewed, advocating safe use of oxygen by encouraging target saturation levels to be prescribed for each patient, based on a combination of what is believed to be safe and normal or near-normal. In the majority of patients a target saturation range of 94–98% is advised. The importance of recognition of patients at risk of type 2 respiratory failure is highlighted and, in such patients, a target saturation range of 88–92% is recommended.

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Section: Statement Of Interestmentioning

confidence: 99%

“…The four reported deaths due to over-oxygenation are thought to be a gross underestimation as previous work in COPD has estimated that, in the UK, a few thousand deaths could be avoided each year by controlled oxygen use [16,17,20,21]. The NPSA relies on clinicians reporting adverse events.…”

Section: Statement Of Interestmentioning

confidence: 99%

Emergency oxygen therapy: from guideline to implementation

Kane

Decalmer

O’Driscoll

2013

Breathe

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“…Oxygen therapy for individuals experiencing acute dyspnea may be complicated by the presence of co-morbidities such as asthma, heart failure, pneumonia, and sleep apnea. These individuals may require higher concentration of oxygen therapy and intense monitoring of their respiratory status is essential [79] .…”

Section: Oxygen Therapymentioning

confidence: 99%

“…When treating acute or unstable dyspnea, usual treatment should include appropriate controlled oxygen therapy via a high flow system to maintain oxygen saturation greater than or equal to 90-92% [78] . Clinical status should be monitored carefully by continuous oximetry or arterial blood gases measurements [79] . Oxygen therapy for individuals experiencing acute dyspnea may be complicated by the presence of co-morbidities such as asthma, heart failure, pneumonia, and sleep apnea.…”

Section: Oxygen Therapymentioning

confidence: 99%

Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD

Bailey

Boyles

Cloutier

et al. 2013

JNEP

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Aim: The aim of this paper is to highlight evidence and key nursing practice, education, organization and policy recommendations from the original and revised Registered Nurses' Association of Ontario Best Practice Guideline, Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD). This paper introduces the notion of dyspnea as the sixth vital sign and presents evidence from the RNAO Best Practice Guideline and other relevant literature to support and enhance nursing care of dyspnea in clients with COPD.Background: COPD is an increasingly serious health issue. Nurses have significant opportunity to positively influence client outcomes and quality of life by assessing dyspnea, identifying problems, and applying appropriate evidence-based interventions. Best practice guidelines developed by the RNAO provide a framework to enhance nursing practice and client care.Design: A panel of nurses was assembled for the initial development of the guideline and more recently, the revision to the original guideline.Method: A structured evidence review based on the scope of the original guideline and supported by three clinical questions was conducted to capture the relevant literature and guidelines published since the original publication.Results: As a result of this work recommendations for nursing practice and education are discussed. Organizational and policy recommendations are also outlined. Conclusions:Nurses have opportunity to positively influence client outcomes and quality of life by assessing dyspnea, identifying problems, and applying appropriate evidence-based interventions.Relevance to Clinical Practice: Recommendations made in the best practice guideline will enhance nursing care of dyspnea in clients with COPD and dyspnea should be recognized as the sixth vital sign in individuals with COPD.

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“…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.…”

Section: Clinical Medicinementioning

confidence: 99%