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McDonald CF, Serginson J, AlShareef S, Buchan C, Davies H, Miller BR, Munsif M, Smallwood N, Troy L, Khor YH. Thoracic Society of Australia and New Zealand clinical practice guideline on adult home oxygen therapy. Respirology 2024; 29:765-784. [PMID: 39009413 DOI: 10.1111/resp.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/27/2024] [Indexed: 07/17/2024]
Abstract
This Thoracic Society of Australia and New Zealand Guideline on the provision of home oxygen therapy in adults updates a previous Guideline from 2015. The Guideline is based upon a systematic review and meta-analysis of literature to September 2022 and the strength of recommendations is based on GRADE methodology. Long-term oxygen therapy (LTOT) is recommended for its mortality benefit for patients with COPD and other chronic respiratory diseases who have consistent evidence of significant hypoxaemia at rest (PaO2 ≤ 55 mm Hg or PaO2 ≤59 mm Hg in the presence of hypoxaemic sequalae) while in a stable state. Evidence does not support the use of LTOT for patients with COPD who have moderate hypoxaemia or isolated nocturnal hypoxaemia. In the absence of hypoxaemia, there is no evidence that oxygen provides greater palliation of breathlessness than air. Evidence does not support the use of supplemental oxygen therapy during pulmonary rehabilitation in those with COPD and exertional desaturation but normal resting arterial blood gases. Both positive and negative effects of LTOT have been described, including on quality of life. Education about how and when to use oxygen therapy in order to maximize its benefits, including the use of different delivery devices, expectations and limitations of therapy and information about hazards and risks associated with its use are key when embarking upon this treatment.
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Affiliation(s)
- Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - John Serginson
- Department of Respiratory Medicine, Sunshine Coast Health, Birtinya, Queensland, Australia
- School of Nursing, Midwifery & Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Saad AlShareef
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Catherine Buchan
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Huw Davies
- Respiratory and Sleep Services, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - Belinda R Miller
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Maitri Munsif
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Lauren Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Institute for Academic Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Yet Hong Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Nam J, Sljivic S, Matthews R, Pak J, Agala CB, Nizamani R, King B, Williams FN. Outcomes of COPD Patients with Flame Burn and Inhalation Injuries at a Single Institution. J Burn Care Res 2023; 44:35-41. [PMID: 36181677 DOI: 10.1093/jbcr/irac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Indexed: 01/11/2023]
Abstract
The presence of any comorbid condition may lead to worse outcomes after burn injury. Chronic obstructive pulmonary disease (COPD) is a condition with significant morbidity and mortality. In 2018, about 16 million adults in the United States reported a diagnosis of COPD based on data from the American Lung Association. The objective of this study was to explore the outcomes of patients with COPD admitted to our Burn Center with flame burns and/or inhalation injury. Patients were identified using our Institutional Burn Center registry and linked to the clinical and administrative data. All adult flame-injured and/or inhalation injury-only patients admitted to our burn center between July 1, 2011 and June 30, 2020 were included. Demographics, length of stay, burn, and patient characteristics and outcomes, including mortality, were evaluated. Four thousand three hundred ninety-seven patients were included in the study. Patients were divided into two populations, those with COPD (n = 515) and those without a diagnosis of COPD (n = 3882). Patients with COPD were older, more likely to be white and male, and had smaller sized burns, p < .001. Patients with COPD were more likely to be smokers and have comorbid conditions. There was no statistically significant difference between the incidence of inhalation injury, lengths of stay, or number of ventilator days. Burn size and inhalation injury increased mortality risk regardless of COPD severity, as did age among those not on home oxygen. More studies are needed to determine the genomic or proteomic changes in patients with COPD that lead to worse outcomes after flame injury, and/or inhalation injury alone.
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Affiliation(s)
- Jason Nam
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, North Carolina
| | - Sanja Sljivic
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
| | - Robert Matthews
- Department of Anesthesiology, University of North Carolina School of Medicine, 101 Manning Drive Chapel Hill, North Carolina 27599
| | - Joyce Pak
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina 27599
| | - Chris B Agala
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina 27599
| | - Rabia Nizamani
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
| | - Booker King
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
| | - Felicia N Williams
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
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Yoon JS, Khoo KH, Puthumana JS, Pérez Rivera LR, Keller PR, Lagziel T, Cox CA, Caffrey J, Galiatsatos P, Hultman CS. Outcomes of Patients with Burns Associated with Home Oxygen Therapy: An Institutional Retrospective Review. J Burn Care Res 2022; 43:1024-1031. [DOI: 10.1093/jbcr/irac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Home oxygen therapy (HOT) burns carry high morbidity and mortality. Many patients are active smokers, which is the most frequent cause of oxygen ignition. We conducted a retrospective review at our institution to characterize demographics and outcomes in this patient population. An IRB-approved single-institution retrospective review was conducted for home oxygen therapy burn patients between July 2016 and January 2021. Demographic and clinical outcome data were compared between groups. We identified 100 patients with oxygen therapy burns. Mean age was 66.6 years with a male to female ratio of 1.3:1 and median burn surface area of 1%. In these patients, 97% were on oxygen for COPD and smoking caused 83% of burns. Thirteen were discharged from the emergency department, 35 observed for less than 24 hours, and 52 admitted. For admitted patients, 69.2% were admitted to the ICU, 37% required intubation, and 11.5% required debridement and grafting. Inhalational injury was found in 26.9% of patients, 3.9% underwent tracheostomy, and 17.3% experienced hospital complications. In-hospital mortality was 9.6% and 7.7% were discharged to hospice. 13.5% required readmission within 30 days. Admitted patients had significantly higher rates of admission to the ICU, intubation, and inhalational injury compared to those that were not admitted (p < .01). Most HOT-related burns are caused by smoking and can result in significant morbidity and mortality. Efforts to educate and encourage smoking cessation with more judicious HOT allocation would assist in preventing these unnecessary highly morbid injuries.
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Affiliation(s)
- Joshua S Yoon
- Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center , Baltimore, MD USA
- Department of Surgery, George Washington University Hospital , Washington, DC USA
| | - Kimberly H Khoo
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Joseph S Puthumana
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | | | - Patrick R Keller
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
| | - Carrie A Cox
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University , Baltimore, MD USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University , Baltimore, MD USA
- Adult Burn Center, Johns Hopkins University Bayview Medical Center , Baltimore, MD USA
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Daniels M, Stromps JP, Heitzmann W, Schiefer J, Fuchs PC, Seyhan H. Nexobrid Treatment for Burn Injuries in Patients With Chronic Obstructive Pulmonary Disease and Home Oxygen Therapy. J Burn Care Res 2021; 44:693-697. [PMID: 34197585 DOI: 10.1093/jbcr/irab127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/13/2022]
Abstract
There is an increased risk for burn injuries associated with home oxygen therapy of patients with chronic obstructive pulmonary disease since 10 to 50 % of these patients continue to smoke. Enzymatic eschar removal of facial burns is gaining popularity but intubation of this specific patient group often leads to prolonged weaning and can require tracheostomy. This study dealt with the question if enzymatic debridement in these patients can also be performed in analgosedation. A selective review of the literature regarding burn trauma associated with home oxygen use in patients with COPD was performed, as well as a retrospective analysis of all patients with burn injuries associated with home oxygen use and chronic obstructive pulmonary disease that were admitted to the study clinic. In the literature 1746 patients with burns associated with home oxygen use are described, but none of them received enzymatic debridement. In this study seventeen patients were included. All three patients in this study with facial full-thickness burn injuries received enzymatic debridement. The mortality rate in this cohort was 17.6 % (3/17). Up to date, there is limited experience performing regional anesthesia debridement in patients with COPD. This is the first manuscript describing the use of enzymatic debridement in patients with COPD and home oxygen therapy. We could confirm other studies that intubation of these patients leads to prolonged ventilation hours and increases the probability for poor prognosis. Therefore, we described the treatment of enzymatic debridement in analgosedation without intubation.
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Affiliation(s)
- Marc Daniels
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Jan Philipp Stromps
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Wolfram Heitzmann
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Jennifer Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Harun Seyhan
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
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