Oxygen therapy for hypercapnic patients with chronic obstructive pulmonary disease and acute respiratory failure: a randomized, controlled pilot study.
OBJECTIVE
To investigate the effect of oxygen therapy on outcome and on symptomatic hypercapnia.


METHODS
Randomized, controlled, single-blind study.


METHODS
Multidisciplinary intensive care unit of a university teaching hospital.


METHODS
Patients admitted with a clinical diagnosis of an acute exacerbation of chronic obstructive pulmonary disease and a PaO2 <6.6 kPa (50 mm Hg) and PaCO2 >6.6 kPa (50 mm Hg) on air.


METHODS
Patients received oxygen therapy titrated to increase arterial oxygen tension to >6.6 kPa (50 mm Hg) or >9 kPa (70 mm Hg). Patients in the low-oxygen tension group also received doxapram if they developed an acidosis with pH <7.2, whereas those in the high-oxygen tension group received doxapram if they developed symptomatic acidosis. Bronchodilator, steroid, and antibiotic therapy was standardized.


RESULTS
Two patients in the low-oxygen tension group (n = 17) required mechanical ventilation and another one died. No patients in the high-oxygen group (n = 17) had a poor outcome, but this difference was not significant. No patient in either group became comatose or developed an acute cardiac arrhythmia.


CONCLUSIONS
Traditional teaching related to oxygen therapy for hypercapnic patients with an acute exacerbation of chronic obstructive pulmonary disease may be incorrect. A large randomized, controlled study is required to confirm this impression.
Gomersall
Charles D
CD
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT.
Joynt
Gavin M
GM
Freebairn
Ross C
RC
Lai
Christopher K W
CK
Oh
Teik E
TE
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D010102:Oxygen Inhalation Therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*