Acute oxygen therapy: a cross-sectional study of prescribing practices at an English hospital immediately before COVID-19 pandemic

Abstract

Background: Approximately 14% of UK hospital in-patients receive supplemental oxygen therapy, only 57% have valid prescriptions. Oxygen must be optimally prescribed to ensure maximal therapeutic response whilst minimizing adverse outcomes (including fatality). This study investigates prescription compliance. Methods: All adults admitted to medical wards (18 February to 3 March 2020) were included. Analyses present proportions, descriptive statistics, and hypothesis testing. Ethical approval was unnecessary for this audit. Results: Of the 636 patients admitted, 66 (10%) were receiving oxygen therapy. Ages ranged from 34 to 100 years with 36 (54.5%) males and 30 (45.5%) females. The prescription was not documented in the oxygen section of the drug chart (n = 37, 56.1%, p = 0.389), nor did it have the physicians signature (n = 40, 60.6%, p = 0.110) nor date (n = 46, 69.7%, p = 0.002). Thirteen chronic obstructive pulmonary disease (COPD) patients (19.7%) were at risk of hypercapnic failure (p = 1.582x10 −6). Target oxygen saturation (SpO2) range had been documented for 30 (45.5%) patients. A target SpO2 range of 88-92% was documented for 9 patients (13.6%), a 94-98% range documented for 11 patients (16.7%). All patients had an invalid prescription. Conclusion: We present real-world practice in naturalistic settings, immediately before pandemiclockdown. Enhanced compliance is advocated to reduce risks of harm and mortality.

Alterations of frontal-temporal gray matter volume associate with clinical measures of older adults with COVID-19

“…Fever has been recognized as the most common symptom of hospitalized COVID-19 patients ( Benussi et al, 2020 ; Ng et al, 2020 ; Qiu et al, 2020 ; Wang et al, 2020 ). Oxygen therapy has been widely taken for COVID-19 patients ( Barrett et al, 2020 ; Hassan et al, 2020 ; Kayem et al, 2020 ; Liu et al, 2020 ; Paganini et al, 2020 ).…”

Automated Oxygen Administration Alleviates Dyspnea in Patients Admitted with Acute Exacerbation of COPD: A Randomized Controlled Trial

“…A "side effect" identified across settings by several observational studies, showing a severe tendency of hyperoxygenation in patients hospitalized with AECOPD, increasing their risk of hypercapnic respiratory failure. [46][47][48][49] The association between the fraction of time with hypoxemia or hyperoxemia and specific items on the MDP in patients admitted with AECOPD needs to be investigated further.…”

Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation

“…Studies on optimal target oxygenation in patients with COVID-19-associated ARF are scarce, and no RCTs have been performed to the best of our knowledge. An additional challenge on this subject is the traditional mode of prescribing oxygen therapy, which is often not documented or specified to the degree, which is common with pharmaceutical therapies [ 24 ]. Patients with COVID-19-associated ARF, despite the provision of maximal oxygen levels via a face mask, should be promptly identified and evaluated with a view to providing respiratory support via HFNC, CPAP, or intubation and mechanical ventilation [ 25 ] ( Figure 1 ).…”