Prescription Of Oxygen Therapy Research Articles

Clinical Audit: Oxygen Prescription with Target Saturations in Post Anesthesia Care Unit

Background: Supplemental oxygen therapy is commonly administered to the majority of postoperative surgical patients in order to prevent hypoxemia, which is one of the most common and significant respiratory problems following surgery. Furthermore, although regular supplemental oxygen administration is not advised for non-hypoxemic patients suffering from a number of acute conditions, including acute coronary syndrome and stroke, high-dose oxygen therapy is advised in a few specific situations to lower the risk of surgical site infections (SSIs) following surgery. In the proposed audit, we examine the practice of oxygen prescription related to the oxygen therapy. According to Choudhury et al. [1], the primary goal of this audit is to evaluate both the physician and nursing team follow the guidelines in the prescription, monitoring, and documentation of oxygen utilization. Its goals are to identify presently non-compliant with local hospital guidelines and provide solutions to help the hospital improve compliance. Methods: 30 patients in PACU were monitored for supplementary oxygen treatment over a month during February 2024. The oxygen prescription of all patients was analyzed using their prescription drug kardex. Result: Out of 30 total patients, there is a valid oxygen therapy prescription in main PACU of CUH (100%), oxygen prescription section in the PACU drug chart completed (3.3%), correct target oxygen saturation is prescribed for the 1 patient (3.3%), patient with a target saturation range (0%), patient have a valid oxygen delivery device prescribed on the drug chart (3.3%), valid time duration for oxygen delivery mentioned in the drug chart (0%), documentation contain observation of oxygen saturation (100%) Conclusions: This audit uncovered major gaps in tertiary care hospital oxygen prescription. As many PACU patients who use supplemental oxygen are still at risk of developing hypoxic injury due to non-complaint with local guidelines for oxygen prescription. The training of physicians and nurses in the use of oxygen should be updated regularly.

Patient Use Patterns of Portable Oxygen Concentrators.

Portable oxygen concentrators (POCs) are medical devices that provide supplemental oxygen to patients requiring long-term oxygen therapy. However, little information is available on day-to-day patterns of how or even whether patients actively switch between their POC mobility features and flow setting options. A retrospective analysis was conducted to assess POC usage among patients who used an Inogen One G5 POC in the USA. This study aimed (1) to describe the patterns of use of POCs, (2) to analyze their compatibility with the prescribed oxygen therapy settings, and (3) to demonstrate the contribution of POC usage to get a standardized long-term oxygen therapy (LTOT). Data were directly downloaded from the devices returned for service or at the end of the Medicare Durable Medical Equipment rental period and streamed via a mobile application from 2018 to 2022. Daily usage, disconnections from the device, use of prescribed pulse delivery settings, breaths per minute, power sources, and movement with the POC were assessed. Device alert histories were also examined. Data revealed a mean daily usage of 4.29 ± 3.23h/day, ranging from 0.35 to 15.52h/day. The prescribed pulse delivery setting was used by 31.34% of patients for at least 80% of their POC use time. When the POC was on battery power, patients were moving/mobile 41.99 ± 33.33% of the time. On the basis of the device-generated alerts, some patients continued to use their POC very close to or even beyond the lifetime of the column/sieve bed. Alerts or alarms potentially requiring repair occurred at a rate of 1.63 events per 100years of use, indicating that device reliability did not significantly influence the use patterns. Patients used their POCs when mobile and at rest. A large proportion of patients adjust their POC settings during the day, which potentially indicates the need for the dynamic individualization of oxygen dose delivery to match activities of daily living or sleep. Patients require follow-up to ensure timely replacement of POC columns.

A KNOWLEDGE, ATTITUDE AND PRACTICE STUDY OF PRESCRIBING OXYGEN AMONGST INTERNS IN A TERTIARY CARE HOSPITAL

Background: Oxygen is one of the most frequently prescribed health-care interventions and resuscitative methods to patients visiting the emergency or while admitted to the hospital. The ongoing COVID pandemic has emphasized the importance of efficient and optimal oxygen utilization. The interns in a teaching hospital are often the first point of contact for patients. Materials and Methods: A cross-sectional questionnaire-based study was done amongst 100 interns posted in areas where oxygen is routinely prescribed. For this study, a questionnaire was devised by the investigators to assess the Knowledge, Attitude and Practice of prescribing oxygen therapy. The questionnaire also included the validated acute oxygen therapy questionnaire (AOTQ). Results: Knowledge of participants ascertained using the validated AOTQ questionnaire revealed a score of 16.59 ± 1.94 out of a maximum of 23 points suggesting that majority of participants possessed mediocre knowledge. The author’s questionnaire showed significant gaps in knowledge and attitude; participants were relatively ill-informed about the interfaces used, the indications, and monitoring required while administering oxygen. Conclusion: There is an admissible gap in knowledge, attitude and practices pertaining to oxygen therapy as compared to the ideal. The development of standard training guidelines and suitable methodologies is absolutely crucial so that optimal therapy can be provided by fresh medical graduates without compromising patient care.

Long-term oxygen therapy prescription in India: Evaluation of compliance, factors affecting compliance, indications, and survival.

Introduction:The international data shows that long-term oxygen therapy (LTOT) compliance is insufficient and variable. We conducted the first study from India on LTOT compliance, factors affecting compliance, indications, and survival through oxygen concentrator.Materials and Methods:Our organization from Delhi had given 378 oxygen concentrators over the last 5 years. We evaluated 120 patients randomly for participating in the study. Compliance was defined as the use of LTOT for at least 15 h/day.Results:Ninety-seven patients were included in the final analysis after exclusion criteria. The compliance to LTOT was seen in 45.36% (44/97). The commonest cause of noncompliance was lack of instructions (49.06%) followed by electricity issues, social stigma, and workplace constraints. A higher PaCO2 was associated with significantly lower compliance (PaCO2 53.18 vs. 44.98 mmHg, P = 0.036). Interstitial lung disease was associated with significantly higher compliance. Oxygen prescription was titrated with arterial blood gas analysis in only 4.12%. The indications for LTOT were chronic obstructive pulmonary disease (49.48%), posttuberculous obstructive airway disease (20.6%), and interstitial lung disease (12.37%). We found a significant reduction in the mean number of exacerbations/year from 3.91 to 1.93 (P < 0.0001). 61.86% of the patients were surviving on LTOT with a median survival time of 12 months.Conclusion:The adherence to LTOT in Indian patients is suboptimal mainly due to lack of instruction and is associated with a higher PaCO2. The practice of titration needs to be followed. The development of a national registry to monitor LTOT should be the long-term target.

Time for change in practice of in-patient oxygen therapy: a period-limited, multidimensional approach to improve oxygen prescription compliance: quality improvement project at Hamad General Hospital, Qatar

Prescription of oxygen therapy has traditionally poor compliance across the globe and mostly given to patients on verbal orders leading to under or overuse. The British Thoracic Society (BTS) guidelines...

EP.TU.785Quality Improvement Project: Improving Oxygen therapy prescription in surgical inpatients

Abstract Aims The 2015, British Thoracic Society (BTS) Oxygen audit demonstrated that 42% of hospital inpatients were using Oxygen without a prescription. National and local standards state that Oxygen, as a drug, should be routinely prescribed and checked along with regular medications and VTE risk assessment. Our baseline audit conducted over a two month period on the surgical wards of a large city hospital revealed that 78% of patients were not being prescribed oxygen. We set a SMART aim to increase the percentage of surgical inpatients being prescribed oxygen by 20% each month. Methods We used the trust e-prescription software to record our data, with three-stage verification and subsequent senior analysis of data. The three primary drivers identified were factors intrinsic to the department: lack of standard awareness, education and safety-net to ensure sustainability. To tackle these in-turns, we designed three PDSA cycles: Departmental poster, seminar with induction material, and system checklist notification. Results Following our first PDSA cycle, the mean percentage increased from 22% to 60%. Using projection analysis, we anticipate this to increase to &amp;gt; 75% after the second PDSA cycle, and &amp;gt;95% after PDSA3, with 100% sustainability one year later. Conclusion Our results to-date show that practice standards have improved following our first PDSA cycle, indicating that awareness played an important role. We predict that education will play an equal role; and given the research supporting the implications of checklists, we forecast that this later element will be the ultimatum leading to 100% sustainability of patients receiving oxygen prescription.

Risk factors for non-invasive/invasive ventilatory support in patients with COVID-19 pneumonia: A retrospective study within a multidisciplinary approach

ObjectivesTo investigate risk factors for non-invasive/invasive ventilatory support (NI/I-VS) in patients with coronavirus disease 2019 (COVID-19). MethodsAll consecutive patients admitted to the Infectious Diseases Unit and Intensive Care Unit (ICU) of Santa Maria Annunziata Hospital (Florence, Italy), from February 25 to April 25, 2020, with a confirmed COVID-19 diagnosis were enrolled in this retrospective cohort study. NI/I-VS was defined as the need for continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) (non-invasive ventilation) or mechanical ventilation, not including low-flow systems of oxygen therapy such as the Venturi mask or nasal cannula. ResultsNinety-seven patients were enrolled; 61.9% (60/97) were male and the median patient age was 64 years. The in-hospital mortality was 9.3%. Thirty-five of the 97 patients (36%) required ICU admission and 94.8% (92/97) were prescribed oxygen therapy: 10.8% (10/92) by nasal cannula, 44.5% (41/92) by Venturi mask, 31.5% (29/92) by CPAP, 2.2% (2/92) by BPAP, and 10.8% (10/92) by mechanical ventilation following intubation. On univariate analysis, patients with a body mass index >30, type II diabetes mellitus, and those presenting with dyspnoea, asthenia, SOFA score ≥2 points, PaO2/FiO2 <300, temperature >38 °C, increased levels of lactate dehydrogenase (LDH), alanine aminotransferase, and C-reactive protein, and a d-dimer >1000 ng/mL at admission more frequently underwent NI/I-VS. Multivariate logistic regression analysis confirmed temperature >38 °C (odds ratio (OR) 21.2, 95% confidential interval (95% CI) 3.5–124.5, p = 0.001), LDH >250 U/l (OR 15.2, 95% CI 1.8–128.8, p = 0.012), and d-dimer >1000 ng/mL (OR 4.5, 95% CI 1.2–17.3, p = 0.027) as significantly associated with the requirement for NI/I-VS. A non-significant trend (p = 0.051) was described for PaO2/FiO2 <300. ConclusionsTemperature >38 °C, LDH > 250 U/l, and d-dimer >1000 ng/mL were found to be independent risk factors for NI/I-VS in COVID-19 patients. In order to quickly identify patients likely at risk of developing a critical illness, inflammatory markers should be assessed upon hospital admission.

Current practice of prescription and administration of oxygen therapy: An observational study at a single teaching hospital.

ObjectivesOxygen therapy, commonly used clinically, should be administered according to the physician's prescription; however, accumulating evidence signals some degree of inaccuracy in this perspective. This study aimed to evaluate the current practice of prescription and administration of oxygen therapy.MethodsThis observational study was conducted at a teaching hospital in the Eastern province of KSA. All inpatients in general wards who were on supplemental oxygen (O2) were included. Patient's demographic data and physician's prescription items were collected from patient medical charts and the respiratory care (RC) department charts. Oxygen administration to inpatients was monitored and matched with oxygen prescriptions recorded on the medical and RC charts.ResultsAmong 152 inpatients, 21 were on supplemental O2. Of these, 20 had written prescriptions in their medical charts, but only 18 had information recorded in the RC charts. Of the 5 items required by hospital guidelines for oxygen prescription, 30% of patients had 3 items; whereas 70% of patients had only 2 items. Mode of oxygen delivery was recommended in all physicians' prescriptions, but flow rate and FiO2 were ordered in only 30% of prescriptions. Among the 6 patients with a written record of target SpO2 range, 2 had a value outside of the target range and 2 of 6 patients had a flow rate that differed from the prescribed rate.ConclusionCurrent practice for oxygen therapy prescription and administration was suboptimal. Nation-wide investigations and remediations of oxygen therapy practice is needed to improve patient care.

Low-Flow Domiciliary Oxygen as a Mechanism of Ongoing Oxidative Stress.

Oxidative stress occurs when imbalances exist between the production of oxygen free radicals and endogenous antioxidants that neutralize their harmful effects, causing irreversible tissue damage. Oxygen free radicals readily interact with DNA, proteins, and lipids, instigating conformational changes to cellular structures and leading to derangement and dysfunction. Oxidative stress is a key feature in the pathology of COPD. As disease progression occurs, supplemental oxygen is often warranted to ameliorate dyspnea. It has been established that supplemental oxygen at > 0.60 FIO2 is an instigator of oxidative stress. We sought to determine whether chronic exposure to low-flow domiciliary oxygen served as a mechanism of ongoing oxidative stress in this patient population. This study serves to inform best practices for low-flow domiciliary oxygen therapy. We utilized prospective data collection for this study. The exhaled-breath condensate (EBC) of 52 subjects with COPD (FEV1 < 70% of predicted normal for age and gender, height, weight, and smoking history) was evaluated for isofuran (IsoF), an oxidative stress biomarker synthesized in response to elevated tissue oxygen tension. The active control group (n = 26) was compared to the active treatment group receiving low-flow domiciliary oxygen for ≥ 6 h/d (n = 26). The active control group generated a mean ± SD EBC IsoF level of 35.81 ± 25.0 pg/mL compared to the active treatment group's level of 51.37 ± 42.2 pg/mL (P = .057). In subjects diagnosed with advanced COPD, chronic exposure to supplemental oxygen therapy at concentrations ≤ 36% did not appear to induce oxidative stress based on EBC IsoF levels. Our findings do not substantiate that chronic exposure to supplemental oxygen at concentrations < 36% instigates oxidative stress, and, therefore, changes to current domiciliary oxygen therapy prescription practices are not warranted.

Literature review of clinical benefits and reasons to prescribe palliative oxygen therapy in non-hypoxaemic patients.

to review current guidelines and studies available to health professionals in the UK and explore the literature to identify reasons for the prescription of palliative oxygen therapy in non-hypoxaemic patients. oxygen therapy is often associated with the palliative treatment for breathlessness. Although prescription guidelines are available and the risks of oxygen therapy are known, the therapy is still prescribed for non-hypoxaemic patients. a literature search was conducted using relevant databases. Cited evidence from published guidelines was also consulted. the findings suggest that oxygen is no more effective than room air for treating dyspnoea for non-hypoxaemic patients, although two small studies of self-reported benefits from patients and carers indicate different perceptions of need. the findings suggest that there is a knowledge gap with regards understanding the reasons for the prescription of oxygen therapy for non-hypoxaemic patients.

Retinal oximetry and systemic arterial oxygen levels.

Retinal oximetry and systemic arterial oxygen levels.

Exertional Desaturation and Prescription of Ambulatory Oxygen Therapy in Interstitial Lung Disease.

Exertional desaturation is an important predictor of mortality in patients with interstitial lung disease. We evaluated the prevalence of exertional desaturation in subjects with interstitial lung disease and determined its relationship with the prescription of ambulatory oxygen therapy. Our retrospective analysis examined prospectively collected data from interstitial lung disease registries of 2 Melbourne hospitals: Alfred Health and Austin Health. All patients with baseline the 6-min walk tests on room air were included. We evaluated the prescription of ambulatory oxygen therapy, up to 3 months after 6-min walk tests, among those with exertional desaturation. Of the 400 subjects, 214 (54%) had exertional desaturation. The prevalence of desaturation increased with the severity of lung function impairment (FVC measurement: 33% for > 75% predicted, 69% for 50-75% predicted, 86% for < 50% predicted; diffusing capacity of the lung for carbon monoxide measurement: 20% for > 55% predicted, 64% for 36-55% predicted, 93% for ≤ 35% predicted, P < .001 for both severity classifications). There was no difference in the prevalence of exertional desaturation among common disease subtypes (P = .17). Among the desaturators, 14 (7%) had resting hypoxemia and all were prescribed long-term oxygen therapy. Of the remaining 200 with exertional desaturation only, 58 (29%) were prescribed ambulatory oxygen therapy. Multiple logistic regression showed independent associations between the ambulatory oxygen therapy prescription and shorter 6-min walk distance (P < .001) as well as worse FVC (% predicted, P = .037). Exertional desaturation is common in subjects with interstitial lung disease. More severely impaired exercise capacity and worse lung function are associated with the prescription of ambulatory oxygen therapy in interstitial lung disease.

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review.

Exercise performance is determined by oxygen supply to working muscles and vital organs. In healthy individuals, exercise performance is limited in the hypoxic environment at altitude, when oxygen delivery is diminished due to the reduced alveolar and arterial oxygen partial pressures. In patients with pulmonary hypertension (PH), exercise performance is already reduced near sea level due to impairments of the pulmonary circulation and gas exchange, and, presumably, these limitations are more pronounced at altitude. In studies performed near sea level in healthy subjects, as well as in patients with PH, maximal performance during progressive ramp exercise and endurance of submaximal constant-load exercise were substantially enhanced by breathing oxygen-enriched air. Both in healthy individuals and in PH patients, these improvements were mediated by a better arterial, muscular, and cerebral oxygenation, along with a reduced sympathetic excitation, as suggested by the reduced heart rate and alveolar ventilation at submaximal isoloads, and an improved pulmonary gas exchange efficiency, especially in patients with PH. In summary, in healthy individuals and in patients with PH, alterations in the inspiratory Po2 by exposure to hypobaric hypoxia or normobaric hyperoxia reduce or enhance exercise performance, respectively, by modifying oxygen delivery to the muscles and the brain, by effects on cardiovascular and respiratory control, and by alterations in pulmonary gas exchange. The understanding of these physiological mechanisms helps in counselling individuals planning altitude or air travel and prescribing oxygen therapy to patients with PH.

The Effect of Supplemental Oxygen in Obesity Hypoventilation Syndrome

Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is a paucity of data regarding its efficacy and safety. The objective of this study was to assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS. In this post hoc analysis of a previous randomized controlled trial, we studied 302 sequentially screened OHS patients who were randomly assigned to noninvasive ventilation, continuous positive airway pressure, or lifestyle modification. Outcomes at 2 mo included arterial blood gases, symptoms, quality of life, blood pressure, polysomnography, spirometry, 6-min walk distance, and hospital resource utilization. Statistical analysis comparing patients with and without oxygen therapy in the three treatment groups was performed using an intention-to-treat analysis. In the noninvasive ventilation group, supplemental oxygen reduced systolic blood pressure although this could be also explained by a reduction in body weight experienced in this group. In the continuous positive airway pressure group, supplemental oxygen increased the frequency of morning confusion. In the lifestyle modification group, supplemental oxygen increased compensatory metabolic alkalosis and decreased the apnea-hypopnea index during sleep. Oxygen therapy was not associated with an increase in hospital resource utilization in any of the groups. After 2 mo of follow-up, chronic oxygen therapy produced marginal changes that were insufficient to consider it, globally, as beneficial or deleterious. Because supplemental oxygen therapy did not increase hospital resource utilization, we recommend prescribing oxygen therapy to patients with OHS who meet criteria with close monitoring. Long-term studies examining outcomes such as incident cardiovascular morbidity and mortality are necessary. Clinicaltrial.gov, ID: NCT01405976.

Acute oxygen therapy: a review of prescribing and delivery practices.

Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care.

Supplemental Oxygen Therapy for Patients with Chronic Obstructive Pulmonary Disease.

Oxygen is necessary for aerobic metabolism. Since the human body cannot produce or store oxygen, a continuous and adequate delivery of oxygen needs to be secured by oxygen uptake from inhaled air via the respiratory system and oxygen delivery to body tissues via the circulation. Severely reduced lung function in advanced chronic obstructive pulmonary disease (COPD) may be a limiting factor for adequate oxygen uptake and patients with this disease may require supplemental oxygen therapy. While the methodology of oxygen delivery in home settings represents a continuously evolving field, oxygen therapy itself has been an integral part of the management of severely hypoxemic patients with COPD for more than 50 years despite the lack of full understanding of its effects and the relative paucity of clinical evidence supporting its use. In this article, we review the physiological effects and discuss the clinical benefits of oxygen therapy. We also evaluate the evidence supporting and arguing against its use in the published literature, discuss its risks and benefits, define criteria for prescribing oxygen therapy, and review methods of oxygen delivery in home settings.

Burn Injury Associated With Home Oxygen Use in Patients With Chronic Obstructive Pulmonary Disease

ObjectivesTo quantify the risk of burn injury associated with home oxygen use and to examine the risk factors associated with the development of this injury. Patients and MethodsWe used a nested case-control and a retrospective cohort design to study enrollment and claims data from a national sample of Medicare beneficiaries 66 years and older with a diagnosis of chronic obstructive pulmonary disease (COPD) from January 1, 2001, through December 31, 2010. The primary outcome was burn injury in patients with COPD prescribed home oxygen. ResultsIn the nested case-control method, patients with burn injury were twice (odds ratio, 2.43; 95% CI, 1.57-3.78) as likely to be prescribed oxygen in the preceding 90 days compared with those without burn injury. In the retrospective cohort study, the absolute risk of burn injury in patients prescribed oxygen therapy was 2.98 per 1000 patients compared with 1.69 per 1000 patients not prescribed oxygen during a 22-month period. The excess risk of a burn injury associated with oxygen was 0.704 per 1000 patients per year, and the number needed to harm was 1421. In multivariable analysis, factors associated with burn injury included male sex, low socioeconomic status, oxygen therapy use, and the presence of 3 or more comorbidities. ConclusionThe benefits of oxygen therapy in patients with COPD outweigh the modest risk of burn injury associated with home oxygen use. However, with the increasing number of patients being prescribed oxygen, health care professionals must educate and counsel patients regarding the potential risk of burn injury.

031. Amiodarone induced pulmonary toxicity (APT).

Male patient aged 68 was transferred to ED due to aggravation of dyspnea that started 10 days before. According to the medical history, he is a coronary patient and an active smoker (40 p/y) who was subject to Coronary artery bypass surgery (CABG) 12 months ago. His medication has included since one year acetylsalicylic acid (100 mg), clopidogrel (75 mg) and amiodarone (200 mg) on a daily basis. The clinical examination detected crackles on both lungs, desaturation (sat 78%, FiO2: 21%), pH: 7.42, pCO2=34.6 mmHg, pO2=45.6 mmHg, HCO3−: 23 mmol/L, bilateral diffuse infiltrates on the chest X-ray and restrictive pattern on PFTs (FVC: 67%, FEV1: 71%, FEV1%: 86.8%, DLCO: 59%). The patient was afebrile with negative markers of infection and we decided immediate discontinuation of amiodarone. The chest HRCT showed patchy loci of organizing pneumonia, traction bronchiectases and extended interstitial fibrosis, imaging compatible with NSIP. Bronchoscopy with BAL revealed a high percentage of lymphocytes (52%), specifically T cytotoxic lymphocytes (CD3+,CD8+), a relatively large percentage of neutrophils (48%) and a very low (0.23) TH/TC ratio in BAL, almost seven times lower than the blood ratio (1.56). We prescribed Oxygen therapy (LTOT) until follow up 20 days later. At follow up there was clear improvement in SpO2, infiltrates and clinical symptoms. The APT is severe and potentially life-threatening while the percentages of incidence ranging between 5% and 13%. Risk factors include a daily dose >400 mg, treatment longer than two months, age over 60 years, antecedent lung disease or surgery and prior angiographic investigations. The most common clinical presentation of chronic APT is a subacute illness characterized by progressive dyspnea on exertion, nonproductive cough and occasionally malaise, weight loss and low-grade fever. HRCT findings include ground glass opacities, interstitial, alveolar or mixed infiltrates, lung nodules or ‘masses’ and pleural thickening. Pulmonary function tests usually reveal low volumes and a restrictive pattern, with a reduction in DLCO of 15-20%. Classic findings on histopathological examination of lung tissues are: foamy macrophages, reactive type II pneumocytes, and endothelial cells with cytoplasmic lamellar inclusions containing phospholipids. Regarding the treatment, if disease extent is limited, discontinuation of amiodarone may be sufficient. Corticosteroids should be given to patients who show substantial involvement on imaging or hypoxemia. Mortality is approximately 10% for those who develop pneumonitis, 20-30% for those admitted to hospital, and 50% for those who develop ARDS.

Prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an : actualisation et consensus médical au sein des hôpitaux universitaires du Grand Ouest (HUGO)

While our European and North American colleagues have recently updated their recommendations, the 2000 Consensus Conference remains the main guideline on management of acute viral bronchiolitis in France. We aimed to establish an updated inter-regional protocol on management of acute viral bronchiolitis in infants. Pediatricians, pediatric pulmonologists, and emergency physicians of the Grand Ouest University Hospitals (France) gathered to analyze the recent data from the literature. Criteria to distinguish childhood asthma from acute viral bronchiolitis were established, then prescriptions of diagnostic tests, antibiotics, and chest physiotherapy were defined and reserved for very limited situations. Similarly, the modalities of oxygen therapy prescription and nutritional support were proposed. Finally, other therapeutics such as nebulized hypertonic saline seem promising, but their place in the treatment of acute bronchiolitis in infants remains unclear. This work has provided new proposals for management of acute viral bronchiolitis and helped standardize practices within the Grand Ouest University Hospitals. This local organization could lay the keystone for working toward guidelines initiated by learned societies at the national level.

Oxygen therapy for cystic fibrosis.

The most serious complications of cystic fibrosis (CF) relate to respiratory insufficiency. Oxygen supplementation therapy has long been a standard of care for individuals with chronic lung diseases associated with hypoxemia. Physicians commonly prescribe oxygen therapy for people with CF when hypoxemia occurs. However, it is unclear if empiric evidence is available to provide indications for this therapy with its financial costs and often profound impact on lifestyle. To assess whether oxygen therapy improves the longevity or quality of life of individuals with CF. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Latest search of Group's Trials Register: 15 May 2013. Randomized or quasi-randomized controlled trials comparing oxygen, administered at any concentration, by any route, in people with documented CF for any time period. Authors independently assessed the risk of bias for included studies and extracted data. This review includes 11 published studies (172 participants); only one examined long-term oxygen therapy (28 participants). There was no statistically significant improvement in survival, lung, or cardiac health. There was an improvement in regular attendance at school or work in those receiving oxygen therapy at 6 and 12 months. Four studies examined the effect of oxygen supplementation during sleep by polysomnography. Although oxygenation improved, mild hypercapnia was noted. Participants fell asleep quicker and spent a reduced percentage of total sleep time in rapid eye movement sleep, but there were no demonstrable improvements in qualitative sleep parameters. Six studies evaluated oxygen supplementation during exercise. Again, oxygenation improved, but mild hypercapnia resulted. Participants receiving oxygen therapy were able to exercise for a significantly longer duration during exercise. Other exercise parameters were not altered by the use of oxygen. There are no published data to guide the prescription of chronic oxygen supplementation to people with advanced lung disease due to CF. Short-term oxygen therapy during sleep and exercise improves oxygenation but is associated with modest and probably clinically inconsequential hypercapnia. There are improvements in exercise duration, time to fall asleep and regular attendance at school or work. There is a need for larger, well-designed clinical trials to assess the benefits of long-term oxygen therapy in people with CF administered continuously or during exercise or sleep or both. However, we do not expect any new research to be undertaken in this area any time soon and do not plan to update this review again until any new evidence does become available.