Titrated Oxygen Linked to Reduced Mortality in COPD

The use of titrated oxygen—compared to routine high-flow oxygen—in the pre-hospital setting has been associated with reduced mortality for patients with chronic obstructive pulmonary disease (COPD), according to research published online in the British Medical Journal.

Researchers in Australia, led by Michael A. Austin of the University of Tasmania, analyzed data from more than 400 patients with presumed acute exacerbation of COPD who were treated by paramedics and taken to the hospital. Patients were randomized to receive conventional high-flow oxygen or titrated oxygen before reaching the hospital, with the main outcomes measuring pre-hospital or in-hospital mortality.

Findings show that titrated oxygen, aiming to keep blood oxygen saturation at 88 percent to 92 percent, in the pre-hospital setting resulted in a 78% reduction in the risk of in-hospital respiratory failure and subsequent mortality for all patients and for patients with a pre-hospital–confirmed COPD diagnosis. Patients with COPD treated with titrated oxygen according to protocol were also significantly less likely to have respiratory acidosis or hypercapnia.

“Our findings provide the first high-quality evidence from a randomized controlled trial for the development of universal guidelines and support the British Thoracic Society’s recent guidelines on acute oxygen treatment, which recommend that oxygen should be administered only at concentrations sufficient to maintain adequate oxygen saturations,” wrote the authors of the study.

While findings may need to be confirmed in larger studies across other health systems, this research will pave the way for implementation of new guidelines. Further, researchers believe that resources for an aggressive campaign of education will still be needed to change the “more is better” oxygen culture that may ignore the potential dangers of hyperoxia.

Click Here to Access the Full Study from the British Medical Journal