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Sardesai I, Grover J, Garg M, Nanayakkara P, Di Somma S, Paladino L, Anderson HL, Gaieski D, Galwankar SC, Stawicki SP. Short Term Home Oxygen Therapy for COVID-19 patients: The COVID-HOT algorithm. J Family Med Prim Care 2020; 9:3209-3219. [PMID: 33102272 PMCID: PMC7567238 DOI: 10.4103/jfmpc.jfmpc_1044_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022] Open
Abstract
Innovative solutions are required to effectively address the unprecedented surge of demand on our healthcare systems created by the COVID-19 pandemic. Home treatment and monitoring of patients who are asymptomatic or mildly symptomatic can be readily implemented to ameliorate the health system burden while maintaining safety and effectiveness of care. Such endeavor requires careful triage and coordination, telemedicine and technology support, workforce and education, as well as robust infrastructure. In the understandable paucity of evidence-based, protocolized approaches toward HOT for COVID-19 patients, our group has created the current document based on the cumulative experience of members of the Joint ACAIM-WACEM COVID-19 Clinical Management Taskforce. Utilizing available evidence-based resources and extensive front-line experience, the authors have suggested a pragmatic pathway for providing safe and effective home oxygen therapy in the community setting.
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Affiliation(s)
- Indrani Sardesai
- Department of Emergency Medicine, Queen Elizabeth Hospital, Gateshead, England, United Kingdom
| | - Joydeep Grover
- Department of Emergency Medicine, Southmead Hospital, Bristol, England, United Kingdom
| | - Manish Garg
- Weill Cornell Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - P.W.B. Nanayakkara
- Section General and Acute Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, University of Rome Sapienza, Rome, Italy
| | | | - Harry L. Anderson
- Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
| | - David Gaieski
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sagar C. Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Florida State University, Sarasota, Florida, USA
| | - Stanislaw P. Stawicki
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
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[Efficacy and patterns of ambulatory oxygen usage - experience of a university hospital]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 17:159-67. [PMID: 21620641 DOI: 10.1016/j.rppneu.2011.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 03/14/2011] [Indexed: 11/23/2022] Open
Abstract
AIMS To determine patterns of ambulatory oxygen (AO) use among patients with chronic obstructive pulmonary disease (COPD) and interstitial lung diseases, and analyze the effects of this therapy on daily activities and quality of life (QoL). PATIENTS AND METHODS We included 37 consecutive adult patients on AO by liquid O(2) for more than three months prescribed by hospital pulmonologists. The acute response to O(2) was evaluated through the standardized 6-minutes walk test (6MWT) and the Borg dyspnea scale during the O(2) pre-intervention trial. Time spent away from home, compliance, side effects and QoL (SF-36 v1 questionnaire) were evaluated by a telephone interview during the follow-up period. Time spent away from home and QoL comparisons after and before the intervention were assessed retrospectively. RESULTS COPD was the most frequent diagnosis (54%), and 29 (78%) patients were already on long-term oxygen therapy. In relation to the acute response to O(2) evaluated through the 6MWT, there were significant improvements in the distance walked (p<0.001), in resting SatO(2) (p<0.001), in minimal SatO(2) (p<0.001), and in percentage of desaturation (p=0.002), independently of the diagnosis. No differences were observed in Borg dyspnea scale. AO was used for a mean of 4.1h/day. Patients spent fewer hours per day away from home after AO treatment (3.5h vs. 5.0h, p<0.025). Six patients (16%) were not compliant to the prescription, and 54% mentioned side effects. We verified low scores in almost all of the sub-domains of SF-36 QoL questionnaire, with a significant improvement noted only in role emotional (p=0.032). Improvement in health global state was described by 49% of patients. CONCLUSIONS Acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities and QoL with AO. More detailed studies are needed to achieve evidence based AO benefits.
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Nonoyama ML, Brooks D, Lacasse Y, Guyatt GH, Goldstein RS. Oxygen therapy during exercise training in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2007; 2007:CD005372. [PMID: 17443585 PMCID: PMC8885311 DOI: 10.1002/14651858.cd005372.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Exercise training within the context of pulmonary rehabilitation improves outcomes of exercise capacity, dyspnea and health-related quality of life in individuals with chronic obstructive pulmonary disease (COPD). Supplemental oxygen in comparison to placebo increases exercise capacity in patients performing single-assessment exercise tests. The addition of supplemental oxygen during exercise training may enable individuals with COPD to tolerate higher levels of activity with less exertional symptoms, ultimately improving quality of life. OBJECTIVES To determine how supplemental oxygen in comparison to control (compressed air or room air) during the exercise-training component of a pulmonary rehabilitation program affects exercise capacity, dyspnea and health-related quality of life in individuals with COPD. SEARCH STRATEGY All records in the Cochrane Airways Group Specialized Register of trials coded as 'COPD' were searched using the following terms: (oxygen* or O2*) AND (exercis* or train* or rehabilitat* or fitness* or physical* or activ* or endur* or exert* or walk* or cycle*). Searching the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE and CINAHL databases identified studies. The last search was carried out in June 2006. SELECTION CRITERIA Only randomized controlled trials (RCTs) comparing oxygen-supplemented exercise training to non-supplemented exercise training (control group) were considered for inclusion. Participants were 18 years or older, diagnosed with COPD and did not meet criteria for long-term oxygen therapy. No studies with mixed populations (pulmonary fibrosis, cystic fibrosis, etc) were included. Exercise training was greater than or equal to three weeks in duration and included a minimum of two sessions a week. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion in the review and extracted data. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Missing data were requested from authors of primary studies. MAIN RESULTS Five RCTs met the inclusion criteria. The maximum number of studies compared in the meta-analysis was three (31 on oxygen versus 32 control participants), because all included studies did not measure the same outcomes. When two studies were pooled, statistically significant improvements of oxygen-supplemented exercise training were found in constant power exercise time, WMD 2.68 minutes (95% CI 0.07 to 5.28 minutes). Supplemental oxygen increased the average exercise time from 6 to 14 minutes; the control intervention increased average exercise time from 6 to 12 minutes. Constant power exercise end-of-test Borg score (on a scale from 1 to 10) also showed statistically significant improvements with oxygen-supplemented exercise training, WMD -1.22 units (95% CI -2.39 to -0.06). One study showed a significant improvement in the change of Borg score after the shuttle walk test, by -1.46 units (95% CI -2.72 to -0.19). There were no significant differences in maximal exercise outcomes, functional exercise outcomes (six-minute walk test), shuttle walk distance, health-related quality of life or oxygenation status. According to the GRADE system most outcomes were rated as low quality because they were limited by study quality. AUTHORS' CONCLUSIONS This review provides little support for oxygen supplementation during exercise training for individuals with COPD, but the evidence is very limited. Studies with larger number of participants and strong design are required to permit strong conclusions, especially for functional outcomes such as symptom alleviation, health-related quality of life and ambulation.
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Affiliation(s)
- M L Nonoyama
- West Park Healthcare Centre, Graduate Department of Rehabilitation Science, 82 Buttonwood Avenue, Toronto, Ontario, Canada, M6M 2J5.
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Abstract
Persons utilizing long term oxygen therapy (LTOT) at home suffer from chronic obstructive pulmonary disease (COPD). Adherence to LTOT ranges from 45% to 70% and utilization of 15 hours per day is widely accepted as efficacious. Although studies have reviewed the level of patient adherence with LTOT, few have introduced or evaluated interventions. The paucity of information regarding patients following oxygen prescription is an enormous void that must be tackled to augment clinical effectiveness and cost containment for the long term. A research agenda for LTOT adherence is postulated to help connect treatment adherence variables and concepts with clinical outcomes and quality of life.
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Affiliation(s)
- D L Cullen
- Department of Family Health Nursing, School of Nursing, Indiana University, Indianapolis, IN, USA
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Abstract
Continuous oxygen therapy (COT) has become widely accepted in the last 20 years in patients with continuous hypoxemia. This review focuses on guidelines for COT, adherence to these guidelines, and the effect of COT on survival, hospitalization, and quality of life. Guidelines for COT are mainly based on three randomized studies where documentation of hypoxemia (P(a)O2 <60mm Hg) and administration of oxygen at least 15 hours/day, are essential. There is less certainty concerning the required correction for hypoxemia, the attitude against current smokers with hypoxemia, the frequency and methods of follow up, and the effect of prescribing domiciliary oxygen to patients with temporary hypoxemia due to a clinically unstable condition (i.e. short-term oxygen therapy [STOT]). The administration of COT to patients with hypoxemic conditions other than COPD rests on extrapolation of data from COPD patients in the NOTT (Nocturnal Oxygen Therapy Trial) and MRC (British Medical Research Council) studies. Adherence to these guidelines is low in general, and very low in some cases. In some countries, STOT accounts for the majority of all prescriptions of domiciliary oxygen, and because nearly half of these patients do not meet the hypoxemia criteria at 3-month follow-up, re-evaluation is mandatory. Only 35%, approximately, of the patients are followed up, and this is one of the main reasons for poor adherence to the hypoxemia criteria. In order to improve the quality of surveillance of COT, more effort has to be put into education of the patients and staff responsible for COT, centralization of the domiciliary organizations, better equipment for ambulation and traveling, and regular follow-up preferably with home visits. The role of an oxygen register on the quality of surveillance of COT has to be determined. The beneficial effect of COT on survival is well established, and some evidence suggests that COT reduces hospitalization. It appears that ambulatory oxygen from liquid source or lightweight cylinders improves disease-specific quality of life modestly in selected patients who partake in regular outdoor activity. Whether COT from oxygen concentrators improves quality of life significantly is, at present, less clear.
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Affiliation(s)
- Thomas J Ringbaek
- Department of Respiratory Medicine, University Hospital of Copenhagen, Hvidovre, Denmark.
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Roberts DH, Lepore JJ, Maroo A, Semigran MJ, Ginns LC. Oxygen therapy improves cardiac index and pulmonary vascular resistance in patients with pulmonary hypertension. Chest 2001; 120:1547-55. [PMID: 11713133 DOI: 10.1378/chest.120.5.1547] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES We tested the hypothesis that breathing 100% oxygen could result in selective pulmonary vasodilatation in patients with pulmonary hypertension, including those patients who would not meet current Health Care Finance Administration guidelines for long-term oxygen therapy. DESIGN, SETTING, AND PATIENTS From 1996 to 1999, 23 adult patients (mean +/- SEM age, 51 +/- 4 years) with pulmonary arterial hypertension without left-heart failure underwent cardiac catheterization in a university teaching hospital while breathing air and then 100% oxygen. MEASUREMENTS AND RESULTS Treatment with 100% oxygen increased arterial oxygen saturation (91 +/- 1% to 99 +/- 0.1%, p < 0.05) and PaO(2) (64 +/- 3 to 309 +/- 28 mm Hg, p < 0.05). Treatment with 100% oxygen also decreased mean pulmonary artery pressure (56 +/- 3 to 53 +/- 2 mm Hg, p < 0.05) and increased cardiac index (2.1 +/- 0.1 to 2.5 +/- 0.2 L/min/m(2), p < 0.05). Calculated mean pulmonary vascular resistance (PVR) decreased from 14.1 +/- 1.4 to 10.6 +/- 1.0 Wood units (p < 0.05). Vasodilatation with 100% oxygen occurred preferentially in the pulmonary circulation (PVR/systemic vascular resistance, 0.53 +/- 0.04 to 0.48 +/- 0.03; p < 0.05). The magnitude of the PVR response to oxygen therapy was correlated only with decreasing patient age (r = 0.45, p < 0.05). CONCLUSIONS Treatment with 100% oxygen is a selective pulmonary vasodilator in patients with pulmonary hypertension, regardless of primary diagnosis, baseline oxygenation, or right ventricular function. Development of disease-specific oxygen prescription guidelines warrants consideration.
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Affiliation(s)
- D H Roberts
- Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Abstract
This review briefly overviews the pathophysiology of dyspnoea and then focuses on discussion of the most frequent causes of chronic and acute dyspnoea in the elderly. The most common causes of dyspnoea in the elderly include heart failure, chronic obstructive pulmonary disease and asthma. Other causes include parenchymal lung disease, pulmonary vascular diseases, upper airway obstruction and pneumonia. Dyspnoea should not be attributed to aging alone. Careful clinical evaluation and spirometry is indicated, and additional testing may be appropriate. In this article, emphasis is placed on the clinical manifestations of dyspnoea in the elderly and an approach to their differential diagnosis is provided. Discussion of available therapy is beyond the scope of this article.
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Affiliation(s)
- J C Yernault
- Department of Respiratory Medicine, Erasme Hospital, Free University of Brussels, Belgium.
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Ringbaek TJ, Lange P, Viskum K. Are patients on long-term oxygen therapy followed up properly? Data from the Danish Oxygen Register. J Intern Med 2001; 250:131-6. [PMID: 11489062 DOI: 10.1046/j.1365-2796.2001.00865.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of the study was to assess the extent and quality of follow-up of patients on LTOT. SETTING The Danish Oxygen Register. SUBJECTS A total of 890 chronic obstructive pulmonary disease (COPD) patients who were on long-term oxygen therapy (LTOT) during the period from 1 November 1994 to 31 August 1995. MAIN OUTCOME MEASURES The extent and quality of follow-up. RESULTS Only 38.5% of the patients were followed up in the study period, and only 17.5% had a 'sufficient follow-up' defined as at least one follow-up visit within 10 months which included measurement of arterial blood gases or pulsoximetry with oxygen supply, verification that the patient used oxygen > or =15 h day-1 and was nonsmoker. Female gender, LTOT initiated 3-12 months ago, LTOT started by a chest physician at pulmonary department and LTOT prescribed > or =15 h day-1 were found to be significant predictors of 'sufficient follow-up' (odds ratio (OR): 1.7, 2.0, 3.7 and 1.9, respectively). CONCLUSIONS The extent and the quality of follow-up of patients on LTOT were poor, especially if a nonpulmonary physician initiated LTOT. We recommend that more attention should be paid on proper monitoring of LTOT, and that only chest physicians should be able to prescribe and re-evaluate LTOT.
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Affiliation(s)
- T J Ringbaek
- Department of Respiratory Medicine, University Hospital of Copenhagen, Hvidovre Hospital, Denmark.
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Abstract
As described throughout this article, significant improvements continue to occur in the pharmacologic management of COPD. These improvements range from improved medication targeting to better understanding of mechanisms of action, to better delivery of medications, to lower side effects. New areas of pharmacologic intervention, if not ready for use today, hold great promise for the not-too-distant future. In addition to the many agents described here, multiple mediator antagonists and anti-inflammatory agents are also under investigation for use in COPD. Interestingly, repair of alveolar tissue may be possible. Indeed, preliminary animal studies suggest that retinoic acid may be able to induce regeneration of lung alveoli. Overall, more effort is needed to broaden awareness and provide for the appropriate diagnosis of COPD, better explain pharmacologic therapies for COPD, simplify and disseminate guidelines, and highlight key differences between asthma and COPD, including their treatment strategies. As interest in COPD continues to grow, future updates on COPD management will continue to add new pharmacologic options for this devastating and preventable disease.
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Affiliation(s)
- G T Ferguson
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, Michigan, USA.
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Knebel AR, Bentz E, Barnes P. Dyspnea management in alpha-1 antitrypsin deficiency: effect of oxygen administration. Nurs Res 2000; 49:333-8. [PMID: 11093698 DOI: 10.1097/00006199-200011000-00007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A deficiency of alpha-1 antitrypsin (AAT) can lead to pulmonary disease in middle-aged adults in whom dyspnea management can be a significant issue. OBJECTIVE The research addressed whether short-term oxygen (O2) administration during activities might decrease dyspnea and improve exercise performance in nonhypoxemic patients with emphysema caused by a deficiency of alpha-1 antitrypsin. METHOD This was a double-blind, randomized crossover study of 31 subjects with a deficiency of AAT (mean + SD, age = 47 +/- 7), moderate emphysema and a resting PaO2 > 70 mm Hg. Oxygen saturation (SpO2), 6-minute walk distance, and end of walk dyspnea were measured during three practice walks and during walks with nasal cannula administration of O2 (intervention) and compressed air (control). RESULTS Repeated measures analysis of variance (ANOVA) showed significant differences across the walks for SpO (F= 18.9, p = 0.0001), 6-minute walk distance (F= 6.07, p = 0.004), and dyspnea (F= 4.44, p = 0.016). Using post hoc contrasts, SpO2 was the only variable that differed between 20, and compressed air (p < 0.0001). There was, however, an interaction effect of gender with O2 for dyspnea (F= 9.85, p = 0.004). Mean values showed that men did not benefit from O2 (p = 0.87). However, women experienced less dyspnea when receiving O2 as compared with compressed air (p = 0.0025), and although not statistically significant, the lower dyspnea with O2 corresponded with an increased walk distance of 79 feet. CONCLUSIONS O2 administration may be useful for reducing dyspnea during exercise in selected populations.
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Affiliation(s)
- A R Knebel
- National Institute of Nursing Research, National Institutes of Health, Clinical Center Nursing Department, Bethesda, Maryland 20892-2178, USA.
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Abstract
The aim of the study was to investigate compliance with long-term oxygen therapy (LTOT), the consumption of mobile oxygen and factors that might influence on these measures. The study included 182 patients with LTOT and 125 patients answered a questionnaire on daily activities. Information on arterial gas tension, lung function, and diagnosis was obtained from the medical file. Data on oxygen systems and the actual usage of oxygen were obtained from the oxygen suppliers. Seventy-six per cent of the patients had a concentrator and 35% had both stationary and mobile oxygen. Good compliance (use of oxygen > 15 h day-1) was seen in 65%. Of the tested factors, only mobile oxygen had an influence on the effective usage. Outdoor activity was reported in 65% of the patients. Only 48% of these patients had mobile units, while 21% of the home-bound patients had mobile units. Of the patients with mobile oxygen, only 39% used their mobile unit > 2 h week-1. Poorer usage of stationary oxygen was observed in patients with outdoor activity (2.4 hours day-1 less). Although only 16 (13%) patients reported a usage less than 15 h day-1, the actual consumption was less than 15 h day-1 in 29%. In conclusion, patients on LTOT tended to overestimate their oxygen usage. Acceptable compliance was observed in 65% of the patients. Only mobile oxygen had a significant impact on the overall compliance. As more patients had outdoor activities than expected, and as these activities had a negative impact on the usage of stationary oxygen, more attention must be paid on detecting outdoor activities. However, as fewer than half of the patients with outdoor activity and mobile oxygen used their mobile systems, there is a need for measures to improve compliance with mobile oxygen. Using lists referring to the actual usage and discussing the usage with the patients may improve the compliance and cost-benefit.
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Affiliation(s)
- T Ringbaek
- Department of Internal Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark.
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Abstract
Over 30 million Americans are living with chronic lung disease in the United States. The long-term ongoing care required by these individuals is a major contributor to American health care costs. Clinicians caring for persons with chronic respiratory disease are faced with minimal time in which to prepare patients for adequate self-care abilities. Often times, the clinician may assume that all of the "bases have been covered." In reality, it is because this assumption is made that persons with chronic respiratory disease are often not receiving the full breadth of information that they need to increase their self-care abilities and optimize their quality of life. This article prepares the perianesthesia clinician to ensure that the important tenets of self-care information are addressed for the person with overt and/or underlying chronic respiratory disease.
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