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26-10-2010 | Respiratory | Article

Titrated better than high-flow oxygen in COPD exacerbations

Abstract

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MedWire News: Titrated oxygen treatment is associated with lower mortality rates than high-flow oxygen treatment in patients suffering an acute exacerbation of chronic obstructive pulmonary disease (COPD), Australian research shows.

"Oxygen is commonly administered to patients with an acute exacerbation of COPD, as well as for a range of other medical emergencies, and can save lives by preventing severe hypoxemia," explain Michael Austin (University of Tasmania, Hobart) and colleagues in the British Medical Journal.

Previous research has suggested that the use of titrated oxygen may be associated with less acidosis, a reduced need for assisted ventilation, and reduced mortality compared with high-flow oxygen treatment in COPD exacerbations. However, the evidence base for the benefit of titrated versus high-flow oxygen treatment is lacking, they add.

The team therefore studied in-hospital mortality data on 405 patients, aged 35 years or older, with a presumed acute COPD exacerbation who were treated with oxygen by paramedics before hospital admission. Of these, 226 received high-flow oxygen and 179 received titrated oxygen.

COPD was subsequently confirmed in 214 patients, of whom 117 received high-flow oxygen and 97 titrated oxygen.

Overall, 9% (n=21) of the 226 high-flow oxygen-treated patients and 4% (n=7) of the 179 titrated oxygen-treated patients died after reaching hospital. In-hospital mortality in the subgroup of 214 patients with confirmed COPD was 9% (n=11) and 2% (n=2) for those who received high-flow and titrated oxygen, respectively.

Analysis revealed that in all patients, use of titrated oxygen was associated with a 58% reduction in relative risk for in-hospital mortality compared with high-flow oxygen.

In patients with confirmed COPD, use of titrated oxygen was associated with a 78% reduction in risk for in-hospital mortality compared with high-flow oxygen.

Furthermore, patients with confirmed COPD who received titrated oxygen were significantly less likely to have respiratory acidosis or hypercapnia than those who received high-flow oxygen.

Austin and team conclude: "Titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory acidosis compared with high flow oxygen in acute exacerbations of COPD."

They add: "These results provide strong evidence to recommend the routine use of titrated oxygen treatment in patients with breathlessness and a history or clinical likelihood of COPD in the prehospital setting."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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