X3.1 Controlled oxygen delivery

Controlled oxygen delivery (28%, or 0.5–2.0 L/min) is indicated for hypoxaemia (Young et al., 1998)

Correction of hypoxaemia to achieve a Pao₂ of at least 55 mmHg (7.3 kPa) and an oxygen saturation of 88%–92% is the immediate priority. (NHLBI/WHO Workshop Report, April 2001) Where there is evidence of acute respiratory acidosis (or a rise in Paco₂), together with signs of increasing respiratory fatigue and/or obtunded conscious state, assisted ventilation should be considered. Early non- invasive positive pressure ventilation (NIPPV) may reduce the need for endotracheal intubation (see below for more detail).

In the emergency setting, oxygen flow should be carefully titrated to achieve arterial oxygen saturations between 88 and 92%. Nasal cannulas, deliver a variable concentration of oxygen, but a flow of 0.5–2.0 L per minute is usually sufficient.

High flow oxygen via a Hudson mask or non-rebreather mask should be avoided, as it is rarely necessary and may lead to hypoventilation and worsening respiratory acidosis and increased mortality. A recent randomised study has demonstrated that in the pre-hospital emergency setting titrated oxygen via nasal cannula compared with high flow oxygen reduced mortality by 78% in COPD patients (NNH=14)(Austin et al., 2010) [[evidence level II].. 

There is currently insufficient evidence to treat acute exacerbations of COPD with Heliox mixture.

< Prev		Next >