Pre-hospital oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

January 01, 0001

Pre-hospital oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

High concentration oxygen is commonly administered during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The aim of this study by researchers from New Zealand was to determine the association between oxygen, severity markers and poor outcomes in AECOPD. In an audit of patients with AECOPD arriving by ambulance to the Emergency Department (ED) of Wellington Hospital, details of oxygen administration, clinical outcomes and severity markers were documented.

Of 250 patients 77 (31%) died, required assisted ventilation or were in respiratory failure. Increased oxygen flow was associated with increasing risk of death, assisted ventilation or respiratory failure with an odds ratio (OR) of 1.2 per 1 L/min oxygen flow. Increasing PaO2 was associated with a greater risk of a poor outcome with an OR of 1.1 per 10mmHg higher PaO2. Home oxygen (OR 2.8), previous respiratory failure (OR 2.6), previous ventilation (OR 3.2) and home nebuliser use (OR 2.4) were associated with an increased risk of a poor outcome.

The researchers concluded: "In AECOPD high flow oxygen in the ambulance is associated with poor clinical outcomes. A number of easily identified markers of chronic disease severity indicate an increased risk of a poor clinical outcome."

The O2 may not be to blame as the O2 may be turned up for those very unwell and / or deteriorating for another reason(s), but the old argument about care with O2 in COPD is noted.

For the full abstract, click here.

Internal Medicine Journal published online 26 Feb 2010 © 2010 Royal Australasian College of Physicians
Pre-hospital oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Meme Wijesinghe, Kyle Perrin, Bridget Healy et al. Correspondence to Richard Beasley: [email protected]

Category: R. Respiratory. Keywords: chronic obstructive pulmonary disease, exacerbation, ambulance, oxygen therapy, respiratory failure, audit, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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