Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial

Bardsley, George; Pilcher, Janine; McKinstry, Steven; Shirtcliffe, Philippa; Berry, James; Fingleton, James; Weatherall, Mark; Beasley, Richard

doi:10.1186/s12890-018-0720-7

Cited by 25 publications

(16 citation statements)

References 18 publications

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“…If an oxygen-driven nebulizer must be used, the advice is to limit this to 6 min, which will deliver most of the bronchodilator drug, although there will still be some rise in the blood carbon dioxide level. 1,73…”

Section: Special Uses Of Oxygen Oxygen As a Driving Gas For Nebulizersmentioning

confidence: 99%

Oxygen Use in Critical Illness

O’Driscoll

Smith

2019

Respir Care

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Oxygen is the most commonly used drug in critical care. However, because it is a gas, most clinicians and most patients do not regard it as a drug. For this reason, the use of medical oxygen over the past century has been driven by custom, practice, and "precautionary principles" rather than by scientific principles. Oxygen is a life-saving drug for patients with severe hypoxemia, but, as with all other drugs, too much can be harmful. It has been known for many decades that the administration of supplemental oxygen is hazardous for some patients with COPD and other patients who are vulnerable to retention of carbon dioxide (ie, hypercapnia). It has been recognized more recently that excessive oxygen therapy is associated with significantly increased mortality in critically ill patients, even in the absence of risk factors for hypercapnia. This paper provides a critical overview of past and present oxygen use for critically ill patients and will provide guidance for safer oxygen use in the future.

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Section: Special Uses Of Oxygen Oxygen As a Driving Gas For Nebulizersmentioning

confidence: 99%

Oxygen Use in Critical Illness

O’Driscoll

Smith

2019

Respir Care

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“…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%

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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“…COPD) are administered drugs (e.g., bronchodilators) via nebulizers using high-dose oxygen as a driving gas instead of compressed air. The inhalation time in this constellation shall be less than 10 min to limit the increase in the partial pressure of carbon dioxide [93][94][95]. Compressed air-driven nebulizers or ultrasonic nebulizers shall be preferred in these patients.…”

Section: Practice Pointsmentioning

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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Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial

Cited by 25 publications

References 18 publications

Oxygen Use in Critical Illness

Oxygen Use in Critical Illness

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

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

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