Source: Annual Congress 2002 - Treatment and outcome of acute respiratory failure in chronic disease
Disease area: Airway diseases

Abstract

Concerns about arterial hypoxaemia and the availability of pulse oximetry have led to high oxygen saturations, despite the known risks, in patients with COPD exacerbations. We wished to assess the prevalence of this problem and determine whether initial use of inappropriately high FiO₂ affected patient outcome. We prospectively identified 310 patients with respiratory failure secondary to COPD exacerbations. Mean(SD) age 69.5(10) years, 196(63%) female. Mean FEV₁ (n=201) 0.80(0.34)l. 139/143(93%) of those brought by ambulance received >=40% oxygen. All patients had arterial blood gases on arrival. In 29 FiO₂ was not recorded. These were eliminated from further analysis

Patient characteristics	FiO2 >=40% (n=64)	FiO2 < 40% (n=104)	Air (n=113)
Age (years)	67 (12)	69 (9.3)	71 (9)
% predicted FEV1	30.2 (12.9) n= 34	34.5(14.8) n= 65	36.9 (14.5) n= 77
Respiratory rate (/min)	26(8)	25(6)	23 (5.7)
pH	7.23 (0.09)	7.33 (0.07)	7.39 (0.05)
pCO2 (kPa)	10.1 (2.9)	7.9 (2.2)	6.11 (1.5)
pO2 (kPa)	17.86 (9.9)	8.1 (2.7)	7.2 (1.0)
No (%) referred to ICU	7 (10.9)	8 (7.7)	0
No (%) accepted by ICU	2 (3.1)	3 (2.9)	0
Median (range) length of admission (days)	9 (1-52)	9 (1-66)	8 (1-34)
Hospital mortality (%)	13 (20)	14 (13)	7 (6)

All data are mean (SD) unless stated
In environments where there is little access to ICU for COPD patients, even those who are not acidotic have a high mortality. Those receiving high FiO₂ have a worse prognosis. The reasons for this need further exploration.

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Citations should be made in the following way:
M. Babores, P. M. A. Calverley, L. Davies (Liverpool, United Kingdom). Inappropriate oxygen therapy and its consequences in chronic obstructive pulmonary disease (COPD). Eur Respir J 2002; 20: Suppl. 38, 601

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