Acute oxygen use in hospitalised patients with chronic obstructive pulmonary disease is guideline discordant

Deshpande, Sheetal; Datey, Nainika; Liacos, Alexandra; Joosten, Simon A.; Leong, Paul

doi:10.1111/imj.15318

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Bech¹,

Hansen²,

Ringbæk³

et al. 2023

COPD

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Objective Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect of AOA on multidimensional aspects of dyspnea and as-needed consumption of opioids and benzodiazepines, as opposed to conventional oxygen therapy, in hospitalized patients with Acute Exacerbation of COPD (AECOPD). Method and Patients A multicenter randomized controlled trial across five respiratory wards in the Capital Region of Denmark. Patients admitted with AECOPD (n=157) were allocated 1:1 to either AOA (O2matic Ltd), a closed loop device automatically delivering oxygen according to the patient’s peripheral oxygen saturation (SpO 2 ), or conventional nurse-administered oxygen therapy. Oxygen flows and SpO 2 levels were measured by the O2matic device in both groups, while dyspnea, anxiety, depression, and COPD symptoms were accessed by Patient Reported Outcomes. Results Of the 157 randomized patients, 127 had complete data for the intervention. The AOA reduced patients’ perception of overall unpleasantness significantly on the Multidimensional Dyspnea Profile (MDP) with a difference in medians of −3 ( p =0.003) between the intervention group (n=64) and the control group (n=63). The AOA also provided a significant between group difference in all single items within the sensory domain of the MDP (all p -values≤0.05) as well as in the Visual Analogue Scale – Dyspnea (VAS-D) within the past three days ( p =0.013). All between group differences exceeded the Minimal Clinical Important Difference of the MDP and VAS-D, respectively. AOA did not seem to have an impact on the emotional response domain of the MDP, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, or use of as-needed opioids and/or benzodiazepines (all p -values>0.05). Conclusion AOA reduces both breathing discomfort and physical perception of dyspnea in patients admitted with AECOPD but did not seem to impact the emotional status or other COPD symptoms.

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Section: Discussionmentioning

confidence: 99%

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

Bech¹,

Hansen²,

Ringbæk³

et al. 2023

COPD

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“…Acute oxygen use in hospitalized patients with COPD is often guideline-discordant [76]. Despite all the international guidelines recommending controlled oxygen therapy, overoxygenation is common during the management of AECOPD.…”

Section: Prognosis Of Oxygen-induced Hypercapniamentioning

confidence: 99%

Oxygen-induced hypercapnia: physiological mechanisms and clinical implications

Sarkar

Madabhavi

Kadakol³

2022

Monaldi Arch Chest Dis

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Oxygen is probably the most commonly prescribed drug in the emergency setting and is a life-saving modality as well. However, like any other drug, oxygen therapy may also lead to various adverse effects. Patients with chronic obstructive pulmonary disease (COPD) may develop hypercapnia during supplemental oxygen therapy, particularly if uncontrolled. The risk of hypercapnia is not restricted to COPD only; it has also been reported in patients with morbid obesity, asthma, cystic fibrosis, chest wall skeletal deformities, bronchiectasis, chest wall deformities, or neuromuscular disorders. However, the risk of hypercapnia should not be a deterrent to oxygen therapy in hypoxemic patients with chronic lung diseases, as hypoxemia may lead to life-threatening cardiovascular complications. Various mechanisms leading to the development of oxygen-induced hypercapnia are the abolition of ‘hypoxic drive’, loss of hypoxic vasoconstriction and absorption atelectasis leading to an increase in dead-space ventilation and Haldane effect. The international guideline recommends a target oxygen saturation of 88% to 92% in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and other chronic lung diseases at risk of hypercapnia. Oxygen should be administered only when oxygen saturation is below 88%. We searched PubMed, EMBASE, and the CINAHL from inception to June 2022. We used the following search terms: “Hypercapnia”, “Oxygen therapy in COPD”, “Oxygen-associated hypercapnia”, “oxygen therapy”, and “Hypoxic drive”. All types of study are selected. This review will focus on the physiological mechanisms of oxygen-induced hypercapnia and its clinical implications.

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Patients’ Perspective on Automated Oxygen Administration during Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Qualitative Study Nested in a Randomized Controlled Trial

Bech

Poulsen

Nørholm

et al. 2022

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Acute oxygen use in hospitalised patients with chronic obstructive pulmonary disease is guideline discordant

Cited by 5 publications

References 12 publications

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

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

Oxygen-induced hypercapnia: physiological mechanisms and clinical implications

Patients’ Perspective on Automated Oxygen Administration during Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Qualitative Study Nested in a Randomized Controlled Trial

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