High flow or titrated oxygen for obese medical inpatients: a randomised crossover trial

Pilcher, Janine; Richards, Michael; Eastlake, Leonie; McKinstry, Steven; Bardsley, George; Jefferies, Sarah; Braithwaite, Irene; Weatherall, Mark; Beasley, Richard

doi:10.5694/mja17.00270

Cited by 11 publications

(27 citation statements)

References 24 publications

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“…It is recommended that future studies into the risks of oxygen-induced hypercapnia are undertaken through comparison of high-concentration oxygen to titrated oxygen in the acute respiratory illnesses that complicate neuromuscular disease, kyphoscoliosis and bronchiectasis. In the interim, current evidence of the potential for oxygen-induced hypercapnia to occur across a range of respiratory conditions [6,8,9,12] supports guideline recommendations to titrate oxygen therapy in all patients to avoid the risks of hyperoxaemia as well as hypoxaemia.…”

Section: Resultsmentioning

confidence: 86%

“…Additionally, acutely unwell patients are more likely to have lower SpO 2 levels and elevated PaCO 2 levels. While hypercapnia and hypoxaemia are not necessarily prerequisites for oxygen-induced hypercapnia [38,42], both have been associated with increased likelihood and magnitudes of oxygen-induced elevations in PaCO 2 [10,12,23,25,33,38]. In support of this, previous studies in stable COPD demonstrating significant oxygen-induced increases in PaCO 2 have had participants with lower baseline blood oxygen levels [32,34,35,38], and/or higher baseline PaCO 2 values [23,[32][33][34][35][36][37][38] than the participants in the current three studies.…”

Section: Discussionmentioning

confidence: 99%

“…These include a reduction in hypoxic drive to breathe leading to decreased ventilation, and the release of hypoxic pulmonary vasoconstriction leading to worsening of ventilation-perfusion mismatch and increased alveolar deadspace [5,7]. RCTs report high-concentration oxygen therapy increases PaCO 2 in patients with asthma [8], pneumonia [9], and obesity [10][11][12]. This suggests oxygen-induced hypercapnia might occur in a range of respiratory conditions with abnormal gas exchange and/ or reduced ventilation with respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

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The effect of 50% oxygen on PtCO2 in patients with stable COPD, bronchiectasis, and neuromuscular disease or kyphoscoliosis: randomised cross-over trials

et al. 2020

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Background: High-concentration oxygen therapy causes increased arterial partial pressure of carbon dioxide (PaCO 2) in patients with COPD, asthma, pneumonia, obesity and acute lung injury. The objective of these studies was to investigate whether this physiological response to oxygen therapy occurs in stable patients with neuromuscular disease or kyphoscoliosis, and bronchiectasis. Methods: Three randomised cross-over trials recruited stable patients with neuromuscular disease or kyphoscoliosis (n = 20), bronchiectasis (n = 24), and COPD (n = 24). Participants were randomised to receive 50% oxygen and 21% oxygen (air), each for 30 min, in randomly assigned order. The primary outcome was transcutaneous partial pressure of carbon dioxide (PtCO 2) at 30 min. The primary analysis was a mixed linear model. Results: Sixty six of the 68 participants had baseline PtCO 2 values < 45 mmHg. The intervention baseline adjusted PtCO 2 difference (95% CI) between oxygen and room air after 30 min was 0.2 mmHg (− 0.4 to 0.9), P = 0.40; 0.5 mmHg (− 0.2 to 1.2), P = 0.18; and 1.3 mmHg (0.7 to 1.8), P < 0.001, in the neuromuscular/kyphoscoliosis, bronchiectasis and COPD participants respectively. Conclusions: The small increase in PtCO 2 in the stable COPD patients with high-concentration oxygen therapy contrasts with the marked increases in PaCO 2 seen in the setting of acute exacerbations of COPD. This suggests that the model of studying the effects of high-concentration oxygen therapy in patients with stable respiratory disease is not generalisable to the use of oxygen therapy in the acute clinical setting. Appropriate studies of high-concentration compared to titrated oxygen in acute clinical settings are needed to determine if there is a risk of oxygen-induced hypercapnia in patients with neuromuscular disease, kyphoscoliosis or bronchiectasis.

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Section: Resultsmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of 50% oxygen on PtCO2 in patients with stable COPD, bronchiectasis, and neuromuscular disease or kyphoscoliosis: randomised cross-over trials

et al. 2020

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“…The study designs included randomized (n=2)/non-randomized controlled trials (n=4) 47–49 , 52–54 , 57 , 58 (n=6 involving eight articles), evaluation 56 (n=1), and before–after intervention studies 50 , 51 , 55 (n=3). Settings for six studies 51 , 52 , 54–56 , 58 were inpatient only, while four studies 47–50 , 53 , 57 combined inpatient and community settings with repeat readmissions to the inpatient setting. Total length of stay for the inpatient setting ranged from 1.3 57 to 17 47 weeks for nine of the ten studies.…”

Section: Resultsmentioning

confidence: 99%

“… 47 , 48 Follow-up post-discharge from the inpatient stay was absent in six studies. 51 ,– 52 ,– 54–56 , 58 …”

Section: Resultsmentioning

confidence: 99%

Non-Surgical Interventions for Hospitalized Adults with Class II or Class III Obesity: A Scoping Review

Rees¹,

Collins²,

Vlieger³

et al. 2021

DMSO

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Adult inpatients with Class II or III obesity and comorbidities have a high health burden with frequent hospitalizations. Surgical risk and patient choice can be contraindications to bariatric surgery, which is considered the gold standard treatment. The best approach to non-surgical management for this adult inpatient group is currently unknown. The aim of this scoping review was to summarize current research in the inpatient setting. The unpublished literature and six electronic database searches identified 4,582 articles, with 12 articles (reporting on 10 studies) eligible and included. The literature on the interventions and their key components in the non-surgical care of the adult inpatient with Class II or III obesity were mapped identifying service provision successes and gaps. The articles reported on intensive lifestyle interventions, comparison of oxygen administration regimes, total parenteral nutrition regimens, and pre-surgical rapid weight loss. Study designs included evaluation (n=1), before–after intervention studies (n=3), and randomized/non-randomized controlled trials (n=6). The classification of obesity as a chronic disease is not universal resulting in reduced inpatient treatment options. Recommendations for consumers, practitioner practice, health policy-makers and future research priorities are reported. Further research in the development of cost-effective inpatient models of care is indicated.

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Noninvasive Mechanical Ventilation Physiology and Ventilatory Management in Morbidly Obese Patients

Köksal

Beyoglu

2020

Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care

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High flow or titrated oxygen for obese medical inpatients: a randomised crossover trial

Cited by 11 publications

References 24 publications

The effect of 50% oxygen on PtCO2 in patients with stable COPD, bronchiectasis, and neuromuscular disease or kyphoscoliosis: randomised cross-over trials

The effect of 50% oxygen on PtCO2 in patients with stable COPD, bronchiectasis, and neuromuscular disease or kyphoscoliosis: randomised cross-over trials

Non-Surgical Interventions for Hospitalized Adults with Class II or Class III Obesity: A Scoping Review

Noninvasive Mechanical Ventilation Physiology and Ventilatory Management in Morbidly Obese Patients

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