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Sarkar M, Madabhavi I, Kadakol N. Oxygen-induced hypercapnia: physiological mechanisms and clinical implications. Monaldi Arch Chest Dis 2022. [DOI: 10.4081/monaldi.2022.2399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Oxygen is probably the most commonly prescribed drug in the emergency setting and is a life-saving modality as well. However, like any other drug, oxygen therapy may also lead to various adverse effects. Patients with chronic obstructive pulmonary disease (COPD) may develop hypercapnia during supplemental oxygen therapy, particularly if uncontrolled. The risk of hypercapnia is not restricted to COPD only; it has also been reported in patients with morbid obesity, asthma, cystic fibrosis, chest wall skeletal deformities, bronchiectasis, chest wall deformities, or neuromuscular disorders. However, the risk of hypercapnia should not be a deterrent to oxygen therapy in hypoxemic patients with chronic lung diseases, as hypoxemia may lead to life-threatening cardiovascular complications. Various mechanisms leading to the development of oxygen-induced hypercapnia are the abolition of ‘hypoxic drive’, loss of hypoxic vasoconstriction and absorption atelectasis leading to an increase in dead-space ventilation and Haldane effect. The international guideline recommends a target oxygen saturation of 88% to 92% in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and other chronic lung diseases at risk of hypercapnia. Oxygen should be administered only when oxygen saturation is below 88%. We searched PubMed, EMBASE, and the CINAHL from inception to June 2022. We used the following search terms: “Hypercapnia”, “Oxygen therapy in COPD”, “Oxygen-associated hypercapnia”, “oxygen therapy”, and “Hypoxic drive”. All types of study are selected. This review will focus on the physiological mechanisms of oxygen-induced hypercapnia and its clinical implications.
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Ouanes I, Bouhaouala F, Maatouk S, Lahmar M, Ben Abdallah S, Hammouda Z, Dachraoui F, Ouanes-Besbes L, L'Her E, Abroug F. Automatic oxygen administration and weaning in patients following mechanical ventilation. J Crit Care 2020; 61:45-51. [PMID: 33075609 DOI: 10.1016/j.jcrc.2020.10.005] [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: 03/26/2020] [Revised: 08/06/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate efficacy of FreeO2 device in oxygen weaning of patients after being liberated from mechanical ventilation (MV). METHODS Prospective crossover cohort study in patients admitted to ICU and after MV weaning. FreeO2 curves were recorded during constant flow and FreeO2 modes. Oxygenation parameters and O2 consumption were assessed. RESULTS Fifty one records were obtained in 51 patients (median age, 62 years, 54.9% had COPD, admission for acute respiratory failure in 96%). NIV was used initially in 68.6%. For a median records duration of 2.04 h, the time spent within target SpO2 range was significantly higher with FreeO2 mode compared to constant O2 flow mode [86.92% (77.11-92.39) vs 43.17% (5.08-75.37); p < 0.001]. Time with hyperoxia was lower with FreeO2 mode: 8.68% (2.96-15.59) vs 38.28% (2.02-86.34). Times with hypoxaemia, and with severe desaturation, were similar. At the end of FreeO2 mode, O2 flow was lower than 1 l/min in 28 patients (54.9%), with a median of 0.99 l/min. CONCLUSIONS For the purpose of oxygen weaning in patients recovering from MV, automatic O2 titration with FreeO2 was associated with a substantial reduction in O2 delivery and better oxygenation parameters in comparison with constant O2 flow.
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Affiliation(s)
- I Ouanes
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia; Faculté de Médecine de Monastir, Université de Monastir, Tunisia.
| | - F Bouhaouala
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia
| | - S Maatouk
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia
| | - M Lahmar
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia; Faculté de Médecine de Monastir, Université de Monastir, Tunisia
| | - S Ben Abdallah
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia; Faculté de Médecine de Monastir, Université de Monastir, Tunisia
| | - Z Hammouda
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia; Faculté de Médecine de Monastir, Université de Monastir, Tunisia
| | - F Dachraoui
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia; Faculté de Médecine de Monastir, Université de Monastir, Tunisia
| | - L Ouanes-Besbes
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia; Faculté de Médecine de Monastir, Université de Monastir, Tunisia
| | - E L'Her
- Service de Réanimation Médicale, CHRU de Brest, France; LATIM INSERM UMR 1101, Université de Bretagne Occidentale, Brest, France
| | - F Abroug
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia; Faculté de Médecine de Monastir, Université de Monastir, Tunisia
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Pilcher J, Thayabaran D, Ebmeier S, Williams M, Back G, Collie H, Richards M, Bibby S, Semprini R, Weatherall M, Beasley R. The effect of 50% oxygen on PtCO 2 in patients with stable COPD, bronchiectasis, and neuromuscular disease or kyphoscoliosis: randomised cross-over trials. BMC Pulm Med 2020; 20:125. [PMID: 32380988 PMCID: PMC7203892 DOI: 10.1186/s12890-020-1132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-concentration oxygen therapy causes increased arterial partial pressure of carbon dioxide (PaCO2) in patients with COPD, asthma, pneumonia, obesity and acute lung injury. The objective of these studies was to investigate whether this physiological response to oxygen therapy occurs in stable patients with neuromuscular disease or kyphoscoliosis, and bronchiectasis. METHODS Three randomised cross-over trials recruited stable patients with neuromuscular disease or kyphoscoliosis (n = 20), bronchiectasis (n = 24), and COPD (n = 24). Participants were randomised to receive 50% oxygen and 21% oxygen (air), each for 30 min, in randomly assigned order. The primary outcome was transcutaneous partial pressure of carbon dioxide (PtCO2) at 30 min. The primary analysis was a mixed linear model. RESULTS Sixty six of the 68 participants had baseline PtCO2 values < 45 mmHg. The intervention baseline adjusted PtCO2 difference (95% CI) between oxygen and room air after 30 min was 0.2 mmHg (- 0.4 to 0.9), P = 0.40; 0.5 mmHg (- 0.2 to 1.2), P = 0.18; and 1.3 mmHg (0.7 to 1.8), P < 0.001, in the neuromuscular/kyphoscoliosis, bronchiectasis and COPD participants respectively. CONCLUSIONS The small increase in PtCO2 in the stable COPD patients with high-concentration oxygen therapy contrasts with the marked increases in PaCO2 seen in the setting of acute exacerbations of COPD. This suggests that the model of studying the effects of high-concentration oxygen therapy in patients with stable respiratory disease is not generalisable to the use of oxygen therapy in the acute clinical setting. Appropriate studies of high-concentration compared to titrated oxygen in acute clinical settings are needed to determine if there is a risk of oxygen-induced hypercapnia in patients with neuromuscular disease, kyphoscoliosis or bronchiectasis. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615000970549 Registered 16/9/15, ACTRN12615000971538 Registered 16/9/15 and ACTRN12615001056583 Registered 7/10/15.
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Affiliation(s)
- Janine Pilcher
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
| | - Darmiga Thayabaran
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Stefan Ebmeier
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Mathew Williams
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
| | - Geraldine Back
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Hamish Collie
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Susan Bibby
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Ruth Semprini
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
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Ma J, Tian Y, Li J, Zhang L, Wu M, Zhu L, Liu S. Effect of Bufei Yishen Granules Combined with Electroacupuncture in Rats with Chronic Obstructive Pulmonary Disease via the Regulation of TLR-4/NF- κB Signaling. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:6708645. [PMID: 31275415 PMCID: PMC6560336 DOI: 10.1155/2019/6708645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/29/2019] [Accepted: 05/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The combined therapy of Bufei Yishen granules (BY) and electroacupuncture (EA) has shown good effects clinically in treating chronic obstructive pulmonary disease (COPD). The present study aimed to observe the effects of the BY + EA combination in a COPD rat model and dissect the potential mechanisms via Toll-like receptor (TLR) 4/nuclear factor kappa B (NF-κB) signaling. METHODS The COPD rats were treated with normal saline, aminophylline, Bufei Yishen granules, electroacupuncture, or Bufei Yishen granules combined with electroacupuncture. The pulmonary function; lung tissue histology; levels of inflammatory factors; expression levels of TLR-4, inhibitor of nuclear factor kappa B (IκB), and NF-κB; and activation of NF-κB in the lung tissues were evaluated. RESULTS Pulmonary function was markedly decreased in the COPD rats, and the lung tissue histology of the COPD rats showed severe pathological changes. The pulmonary function and lung tissue morphology in the treatment groups (APL, BY, EA, and BY + EA) were improved. The increased levels of the inflammatory cytokines interleukin (IL)-1β and IL-6 indicated a chronic inflammatory state in the COPD rats. In the BY, EA, and BY + EA groups, the levels of IL-1β and IL-6 were decreased, especially in the BY + EA group. In addition, the mRNA and protein expression levels of TLR-4, IκB, and NF-κB were obviously downregulated in the BY and BY + EA groups; and the NF-κB p65 activation was significantly decreased in the BY, EA, and BY + EA groups. CONCLUSIONS Bufei Yishen granules and electroacupuncture have curative effects in COPD rats, and the combination therapy of Bufei Yishen granules and electroacupuncture is superior. The TLR-4/NF-κB pathway may be involved in the potential mechanisms by which Bufei Yishen granules and electroacupuncture reduce inflammation.
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Affiliation(s)
- Jindi Ma
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Yange Tian
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Jiansheng Li
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Lanxi Zhang
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Mingming Wu
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Lihua Zhu
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Shuai Liu
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
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Heys D, Swain A, Knowles S, Waugh A, Bailey M. An audit of change in clinical practice: from oxygen-driven to air-driven nebulisers for prehospital patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Intern Med J 2017; 48:668-673. [PMID: 29193631 DOI: 10.1111/imj.13684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In developed countries, ambulances normally carry oxygen cylinders, but not compressed air. Treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with oxygen-driven nebulisers can result in hypercapnia and acidosis. Attempts to avoid this have involved interrupted administration of oxygen. However, small battery-powered air nebulisers are now available. This study aims to compare the prehospital oxygen saturations and treatment of patients suffering from AECOPD before and after the introduction of air nebulisers. METHODS The oxygen saturations and treatment of 200 AECOPD patients before and 200 AECOPD patients after the introduction of air nebulisers were compared. Compliance with a target saturation of 88-92% was calculated. RESULTS The median final oxygen saturation was lower for the post-intervention category (94%) than the pre-intervention category (96%). There was an increase in air nebuliser use from 0 to 56% (P < 0.001) and a decrease in oxygen use from 100 to 71.5% (P < 0.001). There was a numerical increase in the proportion of patients arriving at hospital with oxygen saturations of 88-92% following introduction of the air nebulisers (24 vs 16.5%) and a decrease in patients arriving with high saturations (67.5 vs 76.5%). The likelihood of achieving the target oxygen saturations following introduction of air nebulisers increased (odds ratio 1.598; 95% confidence interval 0.974, 2.621). CONCLUSION The introduction of prehospital air nebulisers resulted in a reduction in oxygen therapy in patients with AECOPD and a lower median prehospital oxygen saturation. This study supports the use of air nebulisers in the prehospital setting.
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Affiliation(s)
| | - Andrew Swain
- Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand
| | | | - Amy Waugh
- Wellington Free Ambulance, Wellington, New Zealand
| | - Mark Bailey
- Wellington Free Ambulance, Wellington, New Zealand
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Pilcher J, Richards M, Eastlake L, McKinstry SJ, Bardsley G, Jefferies S, Braithwaite I, Weatherall M, Beasley R. High flow or titrated oxygen for obese medical inpatients: a randomised crossover trial. Med J Aust 2017; 207:430-434. [PMID: 29129174 DOI: 10.5694/mja17.00270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/18/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare the effects on transcutaneous carbon dioxide tension (Ptco2) of high concentration and titrated oxygen therapy in medical inpatients with morbid obesity who were not selected for a pre-existing diagnosis of obesity hypoventilation syndrome. DESIGN A randomised, crossover trial undertaken between February and September 2015. SETTING Internal medicine service, Wellington Regional Hospital, New Zealand. PARTICIPANTS 22 adult inpatients, aged 16 years or more, with a body mass index exceeding 40 kg/m<sup>2</sup>. INTERVENTIONS Participants received in random order two 60-minute interventions, with a minimum 30-minute washout period between treatments: titrated oxygen therapy (oxygen delivered, if required, via nasal prongs to achieve peripheral oxygen saturation [Spo2] of 88-92%), and high concentration oxygen therapy (delivered via Hudson mask at 8 L/min, without regard to Spo2). Ptco2 and Spo2 were recorded at 10-minute intervals. MAIN OUTCOME MEASURE Ptco2 at 60 minutes, adjusted for baseline. RESULTS Baseline Ptco2 was 45 mmHg or lower for 16 participants with full data (73%). The mean difference in Ptco2 between high concentration and titrated oxygen therapy at 60 minutes was 3.2 mmHg (95% CI, 1.3-5.2 mmHg; P = 0.002). CONCLUSION High concentration oxygen therapy increases Ptco2 in morbidly obese patients. Our findings support guidelines that advocate oxygen therapy, if required in patients with morbid obesity, be titrated to achieve a target Spo2 of 88-92%. CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12610000522011.
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Affiliation(s)
- Janine Pilcher
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Leonie Eastlake
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - George Bardsley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Sarah Jefferies
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Mark Weatherall
- Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Pilcher J, Eastlake L, Richards M, Power S, Cripps T, Bibby S, Braithwaite I, Weatherall M, Beasley R. Physiological effects of titrated oxygen via nasal high-flow cannulae in COPD exacerbations: A randomized controlled cross-over trial. Respirology 2017; 22:1149-1155. [DOI: 10.1111/resp.13050] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Janine Pilcher
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Leonie Eastlake
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Sharon Power
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Terrianne Cripps
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Susan Bibby
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand; Wellington New Zealand
- Department of Clinical Research; Victoria University of Wellington School of Biological Science; Wellington New Zealand
- Department of Medicine; Capital and Coast District Health Board; Wellington New Zealand
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Eychenne N, Jaouadi A, Macquart de Terline D, Fratta A, Laribe-Caget S, Steichen O, Fernandez C, Antignac M. [Assessment of physicians' and nurses' knowledge and practices of aerosol therapy]. Rev Mal Respir 2016; 34:553-560. [PMID: 27863827 DOI: 10.1016/j.rmr.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Aerosol therapy is an efficient, but complex procedure. National and international practice guidelines are regularly updated. However, only a few studies have assessed the application of guidelines by users. The aim of this study is to assess the knowledge and practices of physicians and nurses regarding these guidelines. METHODS Two self-administered questionnaires were designed by a working team and presented to physicians and nurses of four university hospitals in Paris. A pharmacy resident collected and analyzed the data with the aid of an online survey website. RESULTS A total of 481 physicians and nurses completed the questionnaires (33 % of physicians and 67 % of nurses). Only 241/480 physicians and nurses (50 %) knew that several intravenous drugs cannot be nebulized. Ninety-four of 422 (22 %) of them always choose oxygen as the driving gas and 239/311 nurses (77 %) think that single use nebulizers can be re-used for the same patient. CONCLUSIONS This survey shows that many physicians and nurses lack knowledge and use inappropriate practices. Based on these results, a booklet has been designed by the working team. This booklet should help health professionals to harmonize practices across hospitals and to follow the guidelines correctly.
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Affiliation(s)
- N Eychenne
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Jaouadi
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - D Macquart de Terline
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - A Fratta
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Armand-Trousseau, 75012 Paris, France
| | - S Laribe-Caget
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Rothschild, 75012 Paris, France
| | - O Steichen
- Service de médecine interne, hôpitaux universitaires Est-Parisien, AP-HP, site Tenon, 75020 Paris, France; Faculté de médecine, UPMC, université Paris 6, Sorbonne universités, 75005 Paris, France
| | - C Fernandez
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; Département de pharmacie clinique, faculté de pharmacie, université Paris Sud, 92290 Châtenay-Malabry, France
| | - M Antignac
- Service de pharmacie, hôpitaux universitaires Est-Parisien, AP-HP, site Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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A randomized, controlled multicentric study of inhaled budesonide and intravenous methylprednisolone in the treatment on acute exacerbation of chronic obstructive pulmonary disease. Respir Med 2016; 121:39-47. [PMID: 27888990 DOI: 10.1016/j.rmed.2016.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Almost all international guidelines recommend corticosteroids for management of exacerbations of chronic obstructive pulmonary disease (COPD), because it leads to improved outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Nevertheless, due to its side effects, there are still concerns regarding the use of systemic corticosteroid (SC). Inhaled corticosteroids (IC) can be used as an alternative to SC, while reducing the risk of occurrence of side effects. PURPOSE To measure the clinical efficacy and side effects of nebulized budesonide and systemic methylprednisolone in AECOPD. METHODS Valid data from 410 AECOPD patients in 10 hospitals was collected. Patients were randomly divided into 2 groups; budesonide group, treated with nebulized budesonide (2 mg 3 times/day); and methylprednisolone group, treated with intravenously injected methylprednisolone (40 mg/day). COPD assessment test (CAT), arterial blood gas analysis, hospitalization days, adverse effects, fasting blood glucose, serum creatinine, alanine aminotransferase levels, and blood drug were measured and analyzed in both groups. RESULTS Symptoms, pulmonary function and arterial blood gas analysis were significantly improved after treatment in both groups (P < 0.05), with no significant differences between them (P > 0.05), while incidence of adverse events in the budesonide group was lower (P < 0.05). No significant differences in CAT score, days of admission, blood gas analysis results and physiological and biochemical indexes were found between the two groups. Patients treated with methylprednisolone showed a higher degree of PaO2 level improvement. CONCLUSION Results show that inhalation of budesonide (2 mg 3 times/day) and systemic methylprednisolone (40 mg/day) had similar clinical outcome in AECOPD. In conclusion, inhaled budesonide is an alternative to systemic corticosteroids in AECOPD treatment.
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Beasley R, Chien J, Douglas J, Eastlake L, Farah C, King G, Moore R, Pilcher J, Richards M, Smith S, Walters H. Target oxygen saturation range: 92-96% Versus 94-98%. Respirology 2016; 22:200-202. [DOI: 10.1111/resp.12879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 06/15/2016] [Accepted: 06/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand; Wellington New Zealand
- Capital Coast District Health Board; Wellington New Zealand
| | - Jimmy Chien
- Ludwig Engel Centre for Respiratory Research; Westmead Hospital and University of Sydney; Sydney New South Wales Australia
| | - James Douglas
- Department of Respiratory Medicine; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Leonie Eastlake
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Claude Farah
- Concord Hospital; Macquarie University and University of Sydney; Sydney New South Wales Australia
| | - Gregory King
- Woolcock Institute of Medical Research; Royal North Shore Hospital and University of Sydney; Sydney New South Wales Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep; Austin Health; Melbourne Victoria Australia
| | - Janine Pilcher
- Medical Research Institute of New Zealand; Wellington New Zealand
- School of Biological Sciences; Victoria University Wellington; Wellington New Zealand
| | - Michael Richards
- Medical Research Institute of New Zealand; Wellington New Zealand
| | - Sheree Smith
- School of Nursing and Midwifery; University of Western Sydney; Sydney New South Wales Australia
| | - Haydn Walters
- CRE for Chronic Respiratory Disease; University of Tasmania; Hobart Tasmania Australia
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Ganesh T, Estrada M, Duffin J, Cheng HL. T2* and T1 assessment of abdominal tissue response to graded hypoxia and hypercapnia using a controlled gas mixing circuit for small animals. J Magn Reson Imaging 2016; 44:305-16. [PMID: 26872559 DOI: 10.1002/jmri.25169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/12/2016] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To characterize T2* and T1 relaxation time response to a wide spectrum of gas challenges in extracranial tissues of healthy rats. MATERIALS AND METHODS A range of graded gas mixtures (hyperoxia, hypercapnia, hypoxia, and hypercapnic hypoxia) were delivered through a controlled gas-mixing circuit to mechanically ventilated and intubated rats. Quantitative magnetic resonance imaging (MRI) was performed on a 3T clinical scanner; T2* and T1 maps were computed to determine tissue response in the liver, kidney cortex, and paraspinal muscles. Heart rate and blood oxygen saturation (SaO2 ) were measured through a rodent oximeter and physiological monitor. RESULTS T2* decreases consistent with lowered SaO2 measurements were observed for hypercapnia and hypoxia, but decreases were significant only in liver and kidney cortex (P < 0.05) for >10% CO2 and <15% O2 , with the new gas stimulus, hypercapnic hypoxia, producing the greatest T2* decrease. Hyperoxia-related T2* increases were accompanied by negligible increases in SaO2 . T1 generally increased, if at all, in the liver and decreased in the kidney. Significance was observed (P < 0.05) only in kidney for >90% O2 and >5% CO2 . CONCLUSION T2* and T1 provide complementary roles for evaluating extracranial tissue response to a broad range of gas challenges. Based on both measured and known physiological responses, our results are consistent with T2* as a sensitive marker of blood oxygen saturation and T1 as a weak marker of blood volume changes. J. Magn. Reson. Imaging 2016;44:305-316.
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Affiliation(s)
- Tameshwar Ganesh
- Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.,Physiology & Experimental Medicine, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Marvin Estrada
- Lab Animal Services, Hospital for Sick Children, Toronto, Canada
| | - James Duffin
- Department of Anesthesia, University of Toronto, Canada
| | - Hai Ling Cheng
- Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.,Physiology & Experimental Medicine, Hospital for Sick Children Research Institute, Toronto, Canada.,The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Canada.,Institute of Biomaterials & Biomedical Engineering, University of Toronto, Canada
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12
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Chow JWY, Khullar K, Katechia K, Klim S, Kelly AM. Controlled oxygen therapy at emergency department presentation increases the likelihood of achieving target oxygen saturations in patients with exacerbations of chronic obstructive pulmonary disease. Emerg Med Australas 2016; 28:44-7. [DOI: 10.1111/1742-6723.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/30/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Keshav Khullar
- Department of Emergency Medicine; Western Health; Melbourne, Victoria Australia
| | - Kashyap Katechia
- Department of Emergency Medicine; Western Health; Melbourne, Victoria Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health; Melbourne, Victoria Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health; Melbourne, Victoria Australia
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13
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Beasley R, Chien J, Douglas J, Eastlake L, Farah C, King G, Moore R, Pilcher J, Richards M, Smith S, Walters H. Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: 'Swimming between the flags'. Respirology 2015; 20:1182-91. [PMID: 26486092 PMCID: PMC4654337 DOI: 10.1111/resp.12620] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/17/2015] [Indexed: 01/07/2023]
Abstract
The purpose of the Thoracic Society of Australia and New Zealand guidelines is to provide simple, practical evidence-based recommendations for the acute use of oxygen in adults in clinical practice. The intended users are all health professionals responsible for the administration and/or monitoring of oxygen therapy in the management of acute medical patients in the community and hospital settings (excluding perioperative and intensive care patients), those responsible for the training of such health professionals, and both public and private health care organizations that deliver oxygen therapy.
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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New ZealandWellington, New Zealand
- Wellington Regional Hospital, Capital and Coast District Health BoardWellington, New Zealand
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute, University of Sydney at Westmead HospitalSydney, New South Wales, Australia
| | - James Douglas
- Thoracic Program, The Prince Charles HospitalBrisbane, Queensland, Australia
| | - Leonie Eastlake
- Medical Research Institute of New ZealandWellington, New Zealand
| | - Claude Farah
- Department of Respiratory Medicine, Concord HospitalSydney, New South Wales, Australia
- Physiology and Imaging Group, Woolcock Institute of Medical ResearchSydney, New South Wales, Australia
- Sydney Medical School, University of SydneySydney, New South Wales, Australia
- Australian School of Advanced Medicine, Macquarie UniversitySydney, New South Wales, Australia
| | - Gregory King
- Physiology and Imaging Group, Woolcock Institute of Medical ResearchSydney, New South Wales, Australia
- Sydney Medical School, University of SydneySydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal North Shore HospitalSydney, New South Wales, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Austin HealthMelbourne, Victoria, Australia
| | - Janine Pilcher
- Medical Research Institute of New ZealandWellington, New Zealand
- Wellington Regional Hospital, Capital and Coast District Health BoardWellington, New Zealand
- School of Biological Sciences, Victoria University of WellingtonWellington, New Zealand
| | - Michael Richards
- Medical Research Institute of New ZealandWellington, New Zealand
| | - Sheree Smith
- School of Nursing and Midwifery, University of Western SydneySydney, New South Wales, Australia
| | - Haydn Walters
- CRE for Chronic Respiratory Disease, University of TasmaniaHobart, Tasmania, Australia
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