The effects of oxygen therapy in patients presenting to an emergency department with exacerbation of chronic obstructive pulmonary disease.
OBJECTIVE
To elucidate oxygen administration practices in the setting of acute exacerbations of chronic obstructive pulmonary disease (COPD) and compare these practices with those recommended in internationally accepted guidelines.


METHODS
Retrospective audit.


METHODS
65 patients admitted to a Melbourne university teaching hospital via the emergency department (ED), identified through medical records by a discharge diagnosis (discharged between 1 June and 30 September 2005) of acute exacerbation of COPD (AECOPD). Those included had respiratory function test results consistent with British Thoracic Society guidelines for the diagnosis of COPD.


METHODS
Length of stay, need for high dependency unit (HDU) admission, use of non-invasive ventilation (NIV), and use of arterial blood gas (ABG) tests.


RESULTS
Our audit showed that 95% of patients defined as retaining carbon dioxide received oxygen at a flow rate greater than 2 L/min. This process began in the ambulance and continued in the ED, often without monitoring of ABG levels. Length of stay was significantly longer (P = 0.029); need for NIV on admission greater (P = 0.0124); and rate of admission to the HDU higher (P = 0.0124) in patients who achieved a partial pressure of arterial oxygen (PaO(2)) >/= 74.5 mmHg compared with those with a PaO(2) < 74.5 mmHg.


CONCLUSIONS
The vast majority of patients with AECOPD presenting to our university teaching hospital receive oxygen therapy outside of internationally accepted guidelines, often without monitoring of ABG levels. The use of high-flow oxygen may contribute to an increased length of stay, more frequent admission to HDU and greater use of NIV among patients who achieve a higher PaO(2).
Joosten
Simon A
SA
Department of Respiratory Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia. drjoosten@hotmail.com
Koh
Mariko S
MS
Bu
Xiaoning
X
Smallwood
David
D
Irving
Louis B
LB
D000368:Aged; D001315:Australia; D001784:Blood Gas Analysis; D004636:Emergency Service, Hospital; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008499:Medical Records; D010100:Oxygen / Q000008:administration & dosage / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies
D010100:Oxygen