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Controlled oxygen therapy at emergency department presentation increases the likelihood of achieving target oxygen saturations in patients with exacerbations of chronic obstructive pulmonary disease
Author(s) -
Chow Joanna Wai Yinn,
Khullar Keshav,
Katechia Kashyap,
Klim Sharon,
Kelly AnneMaree
Publication year - 2016
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12528
Subject(s) - medicine , copd , oxygen therapy , guideline , exacerbation , emergency department , number needed to harm , hypoxia (environmental) , retrospective cohort study , emergency medicine , oxygen , number needed to treat , relative risk , confidence interval , organic chemistry , pathology , psychiatry , chemistry
Objective This study aimed to determine whether initiation of controlled oxygen therapy at ED presentation increased the proportion of patients with chronic obstructive pulmonary disease (COPD) achieving the COPD‐X guideline target SpO 2 range (88–92%) at 30 min and if it impacted total hospital length of stay or in‐hospital mortality. Methods Retrospective cohort study by medical record review of patients admitted to hospital with an exacerbation of COPD. The primary outcome of interest was the proportion of patients achieving the target SpO 2 range at 30 min after ED arrival. Results The proportion of patients with SpO 2 in the target range at 30 min was higher in the controlled oxygen therapy group (32% vs 16%: difference between proportions 16% (95% CI 7–24%); number needed to treat 6) and less likely to be over‐oxygenated (SpO 2 > 95%), 29% versus 54%, difference between proportions 25% (95% CI 14–35%); number needed to harm 4, without an increased likelihood of hypoxia. Length of stay was not different between the groups. Mortality for the controlled oxygen group was 2.7% (95% CI 1.3–5.5%) versus 5.8% for the uncontrolled oxygen group (95% CI 2.9–11.6%); however, this trend was not statistically significant. Conclusion Patients with exacerbations of COPD receiving controlled oxygen therapy were more likely to achieve SpO 2 within the COPD‐X guideline target range without being more likely to be hypoxic. The proportion of patients with SpO 2 within the target range was low, suggesting that further work on processes to optimise oxygenation in this group of patients is needed.