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Researchers in Australia randomized 405 prehospital patients with suspected chronic obstructive pulmonary disease (COPD) to receive standard high-flow oxygen via a nonrebreather mask at 8 to 10 L/minute or oxygen via nasal cannula titrated to a pulse oximetry reading of 88% to 92%. All patients received bronchodilators and steroids.
Prehospital and in-hospital mortality was significantly lower in the titrated oxygen group than in the high-flow oxygen group among all patients (4% vs. 9%; relative risk, 0.42) and among the 214 patients with confirmed COPD (2% vs. 9%; RR, 0.22). Length of hospital stay, ventilation requirements, and arterial blood gas measurements within 30 minutes of emergency department arrival (obtained in only 11% of patients) were similar between treatment groups. In patients with confirmed COPD, those who received titrated oxygen were significantly less likely to experience hypercapnia with respiratory acidosis than were those who received high-flow oxygen.
Austin MA et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: Randomised controlled trial. BMJ 2010 Oct 18; 341:c5462. (http://dx.doi.org/10.1136/bmj.c5462)
O'Driscoll BR and Beasley R. Avoidance of high concentration oxygen in chronic obstructive pulmonary disease. BMJ 2010 Oct 18; 341:c5549. (http://dx.doi.org/10.1136/bmj.c5549)
Comment
We agree with editorialists, who assert that titration to an oxygen saturation of 88% to 92% represents a new “gold standard” for prehospital management of patients with suspected COPD and that “further trials of high concentration oxygen in this condition would not be ethical.”