British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings

O’Driscoll, B R; Howard, Luke; Earis, J. E.; Mak, Vincent

doi:10.1136/bmjresp-2016-000170

Cited by 137 publications

(188 citation statements)

References 9 publications

(10 reference statements)

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“…However, a predefined sample size calculation was performed based on preliminary data in this very specific population (see online supplementary data). Another potential limitation was the slightly high SpO 2 target (94%) compared with general recommendation in patients with COPD (88%–92%) 14. However, this threshold was based on previous observations showing that the use of this 94% SpO 2 target did not induce hypercapnia compared with constant O 2 flows 10.…”

Section: Discussionmentioning

confidence: 99%

Automated O₂ titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial

Vivodtzev

L’Her

Vottero³

et al. 2018

Thorax

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Automatically titrated O flows (FreeO) was compared with constant O flow on exercise capacity, O saturation and risk of hyperoxia-related hypercapnia in patients with severe COPD with baseline hypercapnia and long-term oxygen therapy (LTOT). Twelve patients were enrolled in a randomised double-blind cross-over study to perform exercise with either FreeO or constant flow. Endurance time (primary outcome) and SpO were both significantly improved with FreeOcompared with constant flow (p<0.04), although pCO was similar in both conditions. Automated titration of O significantly and clinically improved endurance walking time in patients with severe COPD receiving LTOT, without worsening of pCO TRIAL REGISTRATION NUMBER: Results , NCT01575327.

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Section: Discussionmentioning

confidence: 99%

Automated O₂ titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial

Vivodtzev

L’Her

Vottero³

et al. 2018

Thorax

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“…In NEWS, oxygen saturations (SpO 2 ) receive increasing weights for values of 95% or less, and oxygen therapy receives a flat weight. However, guidance for the management of patients with type II respiratory failure (T2RF) 7,8 , and those deemed at risk of T2RF before blood gas analysis 7 , suggests lower SpO 2 values (88-92%) should be targeted. Consequently, it is suggested that the NEWS SpO 2 weighting system is inappropriate for patients with/at risk of T2RF [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

et al. 2019

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Aims: To compare the ability of the National Early Warning Score (NEWS) and the National Early Warning Score 2 (NEWS2) to identify patients at risk of in-hospital mortality and other adverse outcomes. Methods:We undertook a multi-centre retrospective observational study at five acute hospitals from two UK NHS Trusts. Data were obtained from completed adult admissions who were not fit enough to be discharged alive on the day of admission. Diagnostic coding and oxygen prescriptions were used to identify patients with type II respiratory failure (T2RF). The primary outcome was in-hospital mortality within 24 h of a vital signs observation.Secondary outcomes included unanticipated intensive care unit admission or cardiac arrest within 24 h of a vital signs observation. Discrimination was assessed using the c-statistic.Results: Among 251,266 adult admissions, 48,898 were identified to be at risk of T2RF by diagnostic coding. In this group, NEWS2 showed statistically significant lower discrimination (c-statistic, 95% CI) for identifying in-hospital mortality within 24 h (0.860, 0.857-0.864) than NEWS (0.881, 0.878-0.884). For 1394 admissions with documented T2RF, discrimination was similar for both systems: NEWS2 (0.841, 0.827-0.855), NEWS (0.862, 0.848-0.875). For all secondary endpoints, NEWS2 showed no improvements in discrimination.Conclusions: NEWS2 modifications to NEWS do not improve discrimination of adverse outcomes in patients with documented T2RF and decrease discrimination in patients at risk of T2RF. Further evaluation of the relationship between SpO 2 values, oxygen therapy and risk should be investigated further before wide-scale adoption of NEWS2.

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“…Once patient has recovered from respiratory failure and weaned from NIV weaning from oxygen should also be started. British Thoracic Society has published evidence based guidelines regarding various aspects of oxygen therapy including weaning [18]. In our ICU, we follow same guidelines for weaning of these patients from oxygen.…”

Section: Evidence Of Utility Of Various Protocolsmentioning

confidence: 99%

Protocols for Weaning From NIV: Appraisal of Evidence

Hadda¹,

Kumari²

2016

Insights Chest Dis

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Before attempting weaning one has to assess whether the patient is ready for wean or not. A patient who has recovered from the underlying condition and has acceptable clinical and physiological parameters (weaning criteria) he / she, is ready for weaning from NIV. The clinical and physiological parameters used in this setting include -arterial pH ≥ 7.35, oxygen haemoglobin saturation (SpO 2 ) > 90% on FiO 2 ≤ 50%, respiratory rate ≤ 25 / min, heart rate ≤ 120 / min, systolic blood pressure ≥ 90 mmHg and no signs of respiratory distress like agitation, diaphoresis or anxiety. Patient satisfying these criteria, there can be three ways by which weaning from NIV may be done -stepwise reduction of duration of NIV use, stepwise reduction in pressure support and immediate withdrawal of NIV.

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British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings

Cited by 137 publications

References 9 publications

Automated O₂ titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial

Automated O₂ titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial

A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

Protocols for Weaning From NIV: Appraisal of Evidence

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British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings

Cited by 137 publications

References 9 publications

Automated O2 titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial

Automated O2 titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial

A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: A multi-centre database study

Protocols for Weaning From NIV: Appraisal of Evidence

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Automated O₂ titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial

Automated O₂ titration improves exercise capacity in patients with hypercapnic chronic obstructive pulmonary disease: a randomised controlled cross-over trial