Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease

Kopsaftis, Zoe; Carson‐Chahhoud, Kristin; Austin, Michael; Wood‐Baker, Richard

doi:10.1002/14651858.cd005534.pub3

Cited by 9 publications

(11 citation statements)

References 49 publications

(16 reference statements)

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“…Estos pacientes pueden desarrollar una hipoventilación alveolar que cursa con hipercapnia e hipoxemia. En un estudio (14) realizado respecto al uso de alto flujo vs. oxigenoterapia convencional en pacientes con EPOC reagudizada en el servicio prehospitalario, se observó una diferencia en la mortalidad con 11 fallecidos con el uso de alto flujo comparado con 2 fallecidos en la terapia estándar. Todas aquellas muertas ocurrieron una vez llegados al hospital, un 70% se produjeron en los primeros 5 días de ingreso.…”

Section: Resultsunclassified

Use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments: a systematized review

Matabuena-Gómez-Limón¹,

Leiva-Cepas²

2021

Actual. Med.

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The aim of this study si to revise the use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments. A systematized database review will be carried out by the search of articles attending the presented subject following a unique approach; restricting the results to findings in the last five years either in Spanish or English. A research performed in paediatric population concluded that the early management of acute respiratory failure and the use of high flow nasal cannulae reduced the hospitalization period and the referral to specialized hospitals, and gave more independence to regional hospitals in its management; reducing, therefore, the number of patients needing the implementation of invasive procedures. With respect to patients with exacerbations of the chronic obstructive pulmonary disease (COPD) and its early management in the prehospital care, an increase in the mortality in those patients who were exposed to high flow compared to the conventional oxygen therapy was observed. Following the results of a meta-analysis, no benefits were found in the use of high flow nasal cannulae opposed to the conventional therapy or NIV in the emergency departments, in terms of need for intubations, failures in the treatment, hospitalization and mortality.The data are inconclusive in all the studies analyzed and there is no agreement between the different authors. There is a scarce piece of bibliography regarding the use of NIV in the emergency departments due to the fact that the majority of the research are focused on the use of this techniques in intensive care units. In conclussion, there is a diversity in the results of the revised articles according to the use of NIV in the emergency departments.

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Section: Resultsunclassified

Use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments: a systematized review

Matabuena-Gómez-Limón¹,

Leiva-Cepas²

2021

Actual. Med.

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“…SpO 2 target ranges in the preclinical setting are not different from those recommended in Figure 2. The insights regarding the benefit of lower SpO 2 target ranges in the prehospital setting were gained especially for patients at risk of hypercapnia (COPD patients with exacerbation) [39,109]. The prehospital setting is characterized by special conditions as blood gas analyzers are often not available and oxygen delivery systems (such as HFNC) and O 2 sources (usually compressed gas cylinders only) are available to a limited extent only.…”

Section: Prehospital Oxygen Therapymentioning

confidence: 99%

German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients

et al. 2021

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Background: Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. Methods: A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System (“The Oxford 2011 Levels of Evidence”) was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. Results: The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. Conclusion: This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.

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“…Furthermore, hyperoxia can also increase the risk of other adverse events [9] (Table 1). Unfavorable clinical outcomes owing to a high fraction of inspired oxygen (FiO 2 ) have been recently reported in critically ill adults, including patients with chronic obstructive pulmonary disease, myocardial infarction, cardiac arrest, stroke, and traumatic brain injury [10][11][12][13][14][15].…”

Section: What Is Orimentioning

confidence: 99%

ORi™: a new indicator of oxygenation

et al. 2021

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In the perioperative period, hypoxemia and hyperoxia are crucial factors that require attention, because they greatly affect patient prognoses. The pulse oximeter has been the only noninvasive monitor that can be used as a reference of oxygenation in current anesthetic management; however, in recent years, a new monitoring method that uses the oxygen reserve index (ORi™) has been developed by Masimo Corp. ORi is an index that reflects the state of moderate hyperoxia (partial pressure of arterial oxygen [PaO2] between 100 and 200 mmHg) using a non-unit scale between 0.00 and 1.00. ORi monitoring performed together with percutaneous oxygen saturation (SpO2) measurements may become an important technique in the field of anesthetic management, for measuring oxygenation reserve capacity. By measuring ORi, it is possible to predict hypoxemia and to detect hyperoxia at an early stage. In this review, we summarize the method of ORi, cautions for its use, and suitable cases for its use. In the near future, the monitoring of oxygen concentrations using ORi may become increasingly common for the management of respiratory function before, after, and during surgery.

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Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease

Abstract: Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease (Review)

Cited by 9 publications

References 49 publications

Use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments: a systematized review

Use of non-invasive ventilation (NIV) in patients with acute respiratory failure in emergency departments: a systematized review

German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients

ORi™: a new indicator of oxygenation

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