Use Of Supplemental Oxygen Therapy Research Articles

Assessment of Knowledge and Associated Factors with Supplemental Oxygen Administration for Critically Ill Patients among Nurses

Oxygen is a commonly used medication. Insufficient oxygen levels in the bloodstream can lead to cellular malfunctions, organ failure, and ultimately, death. Oxygen, much like any other pharmaceutical substance, can be beneficial in reducing mortality when administered correctly, but it can also have adverse effects when misused. The use of supplemental oxygen therapy (SOT) plays a crucial role in preserving the lives of numerous patients suffering from cardio-pulmonary issues, requiring the development of updated guidelines. Objective: To assess the knowledge level of nurses and to identify the associated factors regarding oxygen administration for critical ill patients. Methods: A descriptive cross sectional study carried out among nurses of Shalamar hospital, Lahore with a sample size of 82. A modified form of questionnaire was used to collect data. Statistical chi-square test was utilized to analyze the study findings. Results: This study found that there were 69.5% females and 30.5% were male. Most of them had age between 20 to 30 years. Regarding knowledge level almost 75.6% participants had good knowledge, 19.5% had moderate knowledge with a mean score of 11.37. Furthermore there was a signification association among knowledge level and experience, duration of administration and duration of prescription with p<0.05 while gender, age, qualification and working area were not directly associated with the knowledge level of nurses with p>0.05. Conclusions: Most of participants were female having age between 20 to 30 years. Most of the nurses had good and moderate knowledge regarding supplemental oxygen therapy (SOT). So it needs a continuing education to stay updated regarding new guidelines for oxygen administration.

Serum Electrolytes and Oxygen Saturation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

Background: Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis. Patients with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Although COPD is mostly a chronic disease, a substantial number of patients experience exacerbations that are related to a significantly worse survival result, especially with abnormal serum electrolyte level. Objectives: The aim of this study is to assess the Serum Electrolytes and Oxygen saturation in acute exacerbation of chronic obstructive pulmonary disease patients. Methods: This is an observational study. The study was carried out in the admitted patient’s Department of Medicine, Netrokona Medical College and hospital, Bangladesh. The duration of the study from October 2019 to March 2021. Results: This study shows that the according to age of 120 Patients aged 40 to 69 years. Here according to Age distribution, 6(5%) were <40 years, 8(6.66%) were 40- 49 years, 21(17.5%) were 50-59 years, 48(40%) were 60-69 years and 37 (30.83%) were ≥ 70 years. Distribution of the study according to sex of 120 Patients aged 40 to 69 years. According to gender 102(85%) were Male, 18(15%) were Female. According to Parameter, the Mean±SD of Serum Sodium, Serum Potassium, O2 Flow (L/min), pH, PaCO2 (mmHg), HCO3 (mmol/L), SpO2 (%) and Respiratory Rate (Breaths/min) were 131±5.07, 3.31±0.33, 0.6±0.4, 7.43±0.02, 40±4, 27±2, 90±1.2 and 22±3 respectfully. Conclusions: The levels of parameters should be measured and corrected during AECOPD treatment to decrease mortality and the correct use of supplemental oxygen therapy during exacerbations of COPD is an impor¬tant factor that can strongly influence outcomes.

Clinical and Pregnancy Outcomes of Coronavirus Disease 2019 Among Hospitalized Pregnant Women in the United States.

BackgroundPregnant women with coronavirus disease 2019 (COVID-19) may be at greater risk of poor maternal and pregnancy outcomes. This retrospective analysis reports clinical and pregnancy outcomes among hospitalized pregnant women with COVID-19 in the United States.MethodsThe Premier Healthcare Database—Special Release was used to examine the impact of COVID-19 among pregnant women aged 15–44 years who were hospitalized and who delivered compared with pregnant women without COVID-19. Outcomes evaluated were COVID-19 clinical progression, including the use of supplemental oxygen therapy, intensive care unit admission, critical illness, receipt of invasive mechanical ventilation/extracorporeal membrane oxygenation, maternal death, and pregnancy outcomes, including preterm delivery and stillbirth.ResultsOverall, 473 902 hospitalized pregnant women were included, 8584 (1.8%) of whom had a COVID-19 diagnosis (mean age = 28.4 [standard deviation = 6.1] years; 40% Hispanic). The risk of poor clinical and pregnancy outcomes was greater among pregnant women with COVID-19 compared with pregnant women without a COVID-19 diagnosis in 2020; the risk of poor clinical and pregnancy outcomes increased with increasing age. Hispanic and Black non-Hispanic women were consistently observed to have the highest relative risk of experiencing poor clinical or pregnancy outcomes across all age groups.ConclusionsOverall, COVID-19 had a significant negative impact on maternal health and pregnancy outcomes. These data help inform clinical practice and counseling to pregnant women regarding the risks of COVID-19. Clinical studies evaluating the safety and efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 in pregnant women are urgently needed.

Hyperoxemia Is Associated With Mortality in Critically Ill Children.

Multiple studies among adults have suggested a non-linear relationship between arterial partial pressure of oxygen (PaO2) and clinical outcomes. Meta-analyses in this population suggest that high levels of supplemental oxygen resulting in hyperoxia are associated with mortality. This mini-review focuses on the non-neonatal pediatric literature examining the relationship between PaO2 and mortality. While only one pilot pediatric randomized-controlled trials exists, over the past decade, there have been at least eleven observational studies examining the relationship between PaO2 values and mortality in critically ill children. These analyses of mixed-case pediatric ICU populations have generally reported a parabolic (“u-shaped”) relationship between PaO2 and mortality, similar to that seen in the adult literature. However, the estimates of the point at which hyperoxemia becomes deleterious have varied widely (300–550 mmHg). Where attempted, this effect has been robust to analyses restricted to the first PaO2 value obtained, those obtained within 24 h of admission, anytime during admission, and the number of hyperoxemic blood gases over time. These findings have also been noted when using various methods of risk-adjustment (accounting for severity of illness scores or complex chronic conditions). Similar relationships were found in the majority of studies restricted to patients undergoing care after cardiac arrest. Taken together, the majority of the literature suggests that there is a robust parabolic relationship between PaO2 and risk-adjusted pediatric ICU mortality, but that the exact threshold at which hyperoxemia becomes deleterious is unclear, and likely beyond the typical target value for most clinical indications. Findings suggest that clinicians should remain judicious and thoughtful in the use of supplemental oxygen therapy in critically ill children.

Perioperative adherence to continuous positive airway pressure and its effect on postoperative nocturnal hypoxemia in obstructive sleep apnea patients: a prospective cohort study

BackgroundAlthough continuous positive airway pressure (CPAP) is the first line treatment for obstructive sleep apnea (OSA) patients, the perioperative adherence rate is unclear. The objective of this study was to determine the perioperative adherence rate of patients with OSA with a CPAP prescription and the effect of adherence on nocturnal oxygen saturation.MethodsThis prospective cohort study included adult surgical patients with a diagnosis of OSA with CPAP prescription undergoing elective non-cardiac surgery. Patients were divided into CPAP adherent and non-adherent groups based on duration of usage (≥ 4 h/night). Overnight oximetry was performed preoperatively and on postoperative night 1 and 2 (N1, N2). The primary outcome was adherence rate and the secondary outcome was nocturnal oxygen saturation.ResultsOne hundred and thirty-two patients completed the study. CPAP adherence was 61% preoperatively, 58% on postoperative N1, and 59% on N2. Forty-nine percent were consistently CPAP adherent pre- and postoperatively. Using a linear fixed effects regression, oxygen desaturation index (ODI) was significantly improved by CPAP adherence (p = 0.0011). The interaction term CPAP x N1 was significant (p = 0.0015), suggesting that the effect of CPAP adherence varied on N1 vs preoperatively. There was no benefit of CPAP adherence on postoperative mean SpO2, minimum SpO2, and percentage of sleep duration with SpO2 < 90%. Use of supplemental oxygen therapy was much lower in the CPAP adherent group vs non-adherent group (9.8% vs 46.5%, p < 0.001).ConclusionsAmong patients with a preoperative CPAP prescription, approximately 50% were consistently adherent. CPAP adherence was associated with improved preoperative ODI and the benefit was maintained on N1. These modest effects may be underestimated by a higher severity of OSA in the CPAP adherent group and a higher rate of oxygen supplementation in the non-adherent group.Trial registrationClinicalTrials.Gov registry (NCT02796846).

Oxygen for interstitial lung diseases.

Supplemental oxygen therapy is prescribed for management of hypoxaemia in patients with interstitial lung disease (ILD). This review summarizes current evidence and implications of the use of supplemental oxygen therapy at home and during exercise training in ILD. Despite the significance of hypoxaemia in patients with ILD, there is a lack of high-quality evidence to guide the use of oxygen therapy in this population. Recent studies suggest that ambulatory oxygen may improve symptoms and health-related quality of life in patients with ILD. Long-term oxygen therapy for resting hypoxaemia in ILD is recommended by international guidelines. Supplemental oxygen during exercise may augment training effects, whereas therapeutic effects of nocturnal oxygen therapy are yet to be evaluated in patients with ILD. Nevertheless, it is important to consider the potential burden imposed by oxygen therapy on patients' daily activities of living. Ambulatory oxygen may be considered in ILD patients with exertional hypoxaemia, with long-term oxygen therapy being a standard care for resting hypoxaemia. Trials are currently underway to clarify therapeutic potentials of supplemental oxygen for exertional hypoxaemia and during exercise training in ILD patients, with additional research needed for the evaluation of nocturnal oxygen therapy.

Prehospital use of supplemental oxygen therapy in the non-hypoxic patient

Supplemental oxygen therapy in the prehospital setting can be life saving in the treatment of hypoxaemia. However, it is often administered liberally in a routine manner without clinical indication. In hyperoxaemia, it is associated with a higher risk of morbidity and mortality in acutely ill patients. An audit was performed on the use of supplemental oxygen therapy in the Irish ambulance service, which looked at: reasons for ambulance transfer; delivery device used to administer supplemental oxygen; oxygen saturation levels before and after therapy; and level of the practitioner giving the treatment. The audit results were screened against formal international guidelines, and recommendations were made to improve practice, with a view to re-auditing in the future.

Effects of Conservative Versus Liberal Oxygen Therapy on the Outcomes of Critically Ill Patients: A Systematic Review and Meta-Analysis

Background: The liberal use of supplemental oxygen therapy is common in intensive care units (ICUs) for critically ill patients, but this practice still lacks high-quality evidence, especially for patients receiving mechanical ventilation (MV). We systematically reviewed the effects of conservative versus liberal oxygen therapy in critically ill adults. Methods: We searched the following electronic databases, including dates from Jan 1st, 2001 until Nov 31st, 2018: PubMed/MEDLINE, Embase, the Cochrane (Central) database and Ovid. Randomized controlled clinical trials (RCT), before-and-after trials or cohort studies comparing conservative with liberal oxygen therapy in critically ill adults (aged ≥18 years) were retrieved. The main outcomes were mortality and ventilator-free days, length of stay, and adverse effects assessed by random-effects meta-analyses. We used the GRADEpro Guideline Development Tool and Trial sequential analysis (TSA) to evaluate the quality of evidence and information size, respectively. Meta-regression was conducted to explore heterogeneity among studies. Findings: Five RCTs and 2 before-and-after trials enrolled 16188 ICU patients. Compared with liberal oxygen therapy, a conservative oxygen strategy (maintaining peripheral oxygen [SpO2] ≤ 98% or arterial oxygen partial pressure [PaO2] ≤ 100 mmHg at the lowest possible FiO2) decreased hospital mortality (RR = 0.88; 95% CI, 0.81-0.95; p = 0.002, moderate quality), especially for patients receiving MV (N = 12327; RR = 0.91; 95% CI, 0.84-1.00; p = 0.05, moderate quality). Moreover, it reduced hospital length of stay (Std. MD = -0.04; 95% CI, -0.06- -0.01; p = 0.01, moderate quality) and increased ventilator-free days either at day 28 (Std. MD = 0.04; 95% CI, 0.01-0.08; p = 0.005, low quality) or during ICU stay (Std. MD = 0.49; 95% CI, 0.30-0.68; p < 0.00001, low quality). The incidence of new bacteremia was much lower in the conservative oxygen therapy group (RR = 0.53; 95% CI, 0.30-0.92; p = 0.02, very low quality). TSA indicated that no more clinical studies should be conducted to prove a beneficial effect of conservative oxygen therapy on hospital length of stay rather than ICU length of stay for critically ill patients. Interpretation: In critically ill adults, conservative oxygen therapy improves hospital mortality, decreases hospital length of stay and increases ventilator-free days, without impacting overall adverse effects. More clinical trials with better designs are needed to optimize the strategy of conservative oxygen therapy in ICU. Funding Statement: This work was supported by the National Natural Science Foundations of China (No. 81571874, 81670074, 81870066), the Key Research and Development Plan of Jiangsu Province (BE2018743), the Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX17_0168), Natural Science Foundation of Jiangsu Province (BK20171271), the Jiangsu Provincial Medical Youth Talent (QNRC2016807) and Third Level Talents of the “333 High Level Talents Training Project” in the fifth phase in Jiangsu (LGY2016051). Declaration of Interests: None declared.

Use of Supplemental Oxygen Therapy in Acutely Ill Medical Patients

Sponsoring Organization: BMJ Rapid Recommendations — a collaboration between the MAGIC group and the BMJBackgroundUntil recently, providing

Safe and effective use of supplemental oxygen therapy.

Nurses have an important role in early identification of factors that can compromise oxygen delivery to the lungs and tissues in the body, and in ensuring that patients who may require supplemental oxygen therapy are assessed and managed safely and competently. This article provides an overview of the anatomy and physiology in relation to oxygen delivery to the lungs and tissues in the body, and outlines the common indications and contraindications for supplemental oxygen therapy. It also discusses the approaches that nurses can adopt to assess a patient's clinical need for supplemental oxygen therapy, as well as the safety considerations required.

Ischemic changes associated with a large patent arterial duct in small infants

Infants with a large patent arterial duct (PDA) may develop signs of congestive heart failure secondary to pulmonary overcirculation. As the PVR decreases, the relative pulmonary blood flow (Qp :Qs ) increases and this may cause tachypnea, respiratory distress, failure to thrive, ventricular dysfunction and even ventilator dependency. The diastolic runoff from the systemic circulation may result in intestinal hypoperfusion resulting in necrotizing enterocolitis, and in severe cases, myocardial ischemia. Cardiac ischemia due to coronary steal is a recognized clinical entity. We present two cases of infants who developed coronary artery steal with the use of supplemental oxygen therapy during anesthesia induction for PDA occlusion. These cases highlight the importance of prudent use of supplemental oxygen therapy in infants with large PDAs.

Clinical and radiographic correlates of hypoxemia and oxygen therapy in the COPDGene study

Severe hypoxemia is a major complication of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy is beneficial in hypoxemic COPD patients. However, the clinical and radiographic predictors of hypoxemia and the use of oxygen therapy are not well described. This study aimed to find the correlates of resting hypoxemia and the pattern of oxygen use in moderate to severe COPD patients. Subjects with GOLD stage II or higher COPD from the first 2500 COPDGene subjects were included in this analysis. All subjects were current or ex-smokers between ages 45 and 80. Severe resting hypoxemia was defined as room air oxygen saturation (SpO(2)) ≤88%. Use of supplemental oxygen therapy was determined by questionnaire. Eighty-two of 1060 COPD subjects (7.7%) had severe resting hypoxemia. Twenty-one of the 82 (25.6%) were not using continuous supplemental oxygen. Female sex, higher BMI, lower FEV(1), and enrollment in Denver were independent risk factors for hypoxemia; emphysema severity on quantitative chest CT scan did not predict hypoxemia. 132 of 971(13.6%) subjectswithout severe resting hypoxemia were using continuous supplemental oxygen. Innon-hypoxemic oxygen users, Denver recruitment, higher BMI, lower FEV(1), and more severe dyspnea were associated with the use of continuous oxygen. A large number of COPD patients without severe hypoxemia were using supplemental oxygen therapy and the pattern of oxygen use was affected by factors other than resting SpO(2) and emphysema severity. Longitudinal data will be required to reveal the effects of oxygen therapy in this subgroup. http://clinicaltrials.gov (NCT00608764).

COPD and cognitive impairment: the role of hypoxemia and oxygen therapy

several studies have shown an association between chronic obstructive pulmonary disease (COPD) and cognitive impairment. These studies have been limited by methodological issues such as diagnostic uncertainty, cross-sectional design, small sample size, or lack of appropriate referent group. This study aimed to elucidate the association between COPD and the risk of cognitive impairment compared to referent subjects without COPD. In patients with established COPD, we evaluated the impact of disease severity and impairment of respiratory physiology on cognitive impairment and the potential mitigating role of oxygen therapy. we used the Function, Living, Outcomes and Work (FLOW) cohort study of adults with COPD (n = 1202) and referent subjects matched by age, sex, and race (n = 302) to study the potential risk factors for cognitive impairment among subjects with COPD. Cognitive impairment was defined as a Mini-Mental State Exam score of <24 points. Disease severity was using Forced Expiratory Volume in one second (FEV(1)); the validated COPD Severity Score; and the BMI (Body Mass Index), Obstruction, Dyspnea, Exercise Capacity (BODE) Index. Multivariable analysis was used to control for confounding by age, sex, race, educational attainment, and cigarette smoking. COPD was associated with a substantive risk of cognitive impairment compared to referent subjects (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.043-6.64). Among COPD patients, none of the COPD severity measures were associated with the risk of cognitive impairment (P > 0.20 in all cases). Low baseline oxygen saturation was related to increased risk of cognitive impairment (OR for oxygen saturation ≤88% (OR 5.45; 95% CI 1.014-29.2; P = 0.048). Conversely, regular use of supplemental oxygen therapy decreased the risk for cognitive impairment (OR 0.14; 95% CI 0.07-0.27; P < 0.0001). COPD is a major risk factor for cognitive impairment. Among patients with COPD, hypoxemia is a major contributor and regular use of home oxygen is protective. Health care providers should consider screening their COPD patients for cognitive impairment.

Oxygen Therapy for Patients With COPD: Current Evidence and the Long-Term Oxygen Treatment Trial

Long-term use of supplemental oxygen improves survival in patients with COPD and severe resting hypoxemia. However, the role of oxygen in symptomatic patients with COPD and more moderate hypoxemia at rest and desaturation with activity is unclear. The few long-term reports of supplemental oxygen in this group have been of small size and insufficient to demonstrate a survival benefit. Short-term trials have suggested beneficial effects other than survival in patients with COPD and moderate hypoxemia at rest. In addition, supplemental oxygen appeared to improve exercise performance in small short-term investigations of patients with COPD and moderate hypoxemia at rest and desaturation with exercise, but long-term trials evaluating patient-reported outcomes are lacking. This article reviews the evidence for long-term use of supplemental oxygen therapy and provides a rationale for the National Heart, Lung, and Blood Institute Long-term Oxygen Treatment Trial. The trial plans to enroll subjects with COPD with moderate hypoxemia at rest or desaturation with exercise and compare tailored oxygen therapy to no oxygen therapy.

Management of Pulmonary Arterial Hypertension Associated with Congenital Systemic-to-Pulmonary Shunts and Eisenmenger???s Syndrome

A large proportion of patients with congenital heart disease (CHD), in particular those with relevant systemic-to-pulmonary shunts, will develop pulmonary arterial hypertension (PAH) if left untreated. Persistent exposure of the pulmonary vasculature to increased blood flow, as well as increased pressure, may result in pulmonary obstructive arteriopathy, which leads to increased pulmonary vascular resistance that, if it approaches or exceeds systemic resistance, will result in shunt reversal. Eisenmenger's syndrome, the most advanced form of PAH associated with CHD, is defined as CHD with an initial large systemic-to-pulmonary shunt that induces severe pulmonary vascular disease and PAH, with resultant reversal of the shunt and central cyanosis. The histopathological and pathobiological changes seen in patients with PAH associated with congenital systemic-to-pulmonary shunts, such as endothelial dysfunction of the pulmonary vasculature, are considered similar to those observed in idiopathic or other associated forms of PAH. A pathological and pathophysiological classification of CHD with systemic-to-pulmonary shunt leading to PAH has been developed that includes specific characteristics, such as the type, dimensions and direction of the shunt, extracardiac abnormalities and repair status. A clinically oriented classification has also been proposed. The prevalence of PAH associated with congenital systemic-to-pulmonary shunts in Western countries has been estimated to range between 1.6 and 12.5 cases per million adults, with 25-50% of this population affected by Eisenmenger's syndrome. Clinically, Eisenmenger's syndrome presents with multiple organ involvement, with progressive deterioration of function over time. The signs and symptoms of Eisenmenger's syndrome in the advanced stages include central cyanosis, dyspnoea, fatigue, haemoptysis, syncope and right-sided heart failure. Survival of patients with Eisenmenger's syndrome is clearly less than that of the general population, but appears to be better than that of patients with idiopathic PAH in a comparable functional class. The treatment strategy for patients with PAH associated with congenital systemic-to-pulmonary shunts and, in particular, those with Eisenmenger's syndrome is based mainly on clinical experience rather than being evidence based. General measures include recommendations for physical activity, pregnancy, infections, air travel, exposure to high altitudes and elective surgery, and that psychological assistance be provided as necessary. Phlebotomies are required only when hyperviscosity of the blood is evident, usually when the haematocrit is >65%. The use of supplemental oxygen therapy is controversial and it should be used only in patients in whom it produces a consistent increase in arterial oxygen saturation. Oral anticoagulant treatment with warfarin can be initiated in patients with pulmonary artery thrombosis and absent, or only mild, haemoptysis. The following three classes of drugs targeting the correction of abnormalities in endothelial dysfunction have been approved recently for the treatment of PAH: (i) prostanoids; (ii) endothelin receptor antagonists; and (iii) phosphodiesterase-5 inhibitors. The efficacy and safety of these compounds have been confirmed in uncontrolled studies in patients with PAH associated with corrected and uncorrected congenital systemic-to-pulmonary shunts, as well as in patients with Eisenmenger's syndrome. One randomized controlled trial reported favourable short- and long-term outcomes of treatment with the orally active dual endothelin receptor antagonist bosentan in patients with Eisenmenger's syndrome. Lung transplantation with repair of the cardiac defect or combined heart-lung transplantation are options for Eisenmenger's syndrome patients with a poor prognosis. A treatment algorithm based on the one used in the treatment of PAH patients is proposed for patients with PAH associated with corrected and uncorrected congenital systemic-to-pulmonary shunts and Eisenmenger's syndrome.

Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines

Pulmonary rehabilitation has become a standard of care for patients with chronic lung diseases. This document provides a systematic, evidence-based review of the pulmonary rehabilitation literature that updates the 1997 guidelines published by the American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation. The guideline panel reviewed evidence tables, which were prepared by the ACCP Clinical Research Analyst, that were based on a systematic review of published literature from 1996 to 2004. This guideline updates the previous recommendations and also examines new areas of research relevant to pulmonary rehabilitation. Recommendations were developed by consensus and rated according to the ACCP guideline grading system. The new evidence strengthens the previous recommendations supporting the benefits of lower and upper extremity exercise training and improvements in dyspnea and health-related quality-of-life outcomes of pulmonary rehabilitation. Additional evidence supports improvements in health-care utilization and psychosocial outcomes. There are few additional data about survival. Some new evidence indicates that longer term rehabilitation, maintenance strategies following rehabilitation, and the incorporation of education and strength training in pulmonary rehabilitation are beneficial. Current evidence does not support the routine use of inspiratory muscle training, anabolic drugs, or nutritional supplementation in pulmonary rehabilitation. Evidence does support the use of supplemental oxygen therapy for patients with severe hypoxemia at rest or with exercise. Noninvasive ventilation may be helpful for selected patients with advanced COPD. Finally, pulmonary rehabilitation appears to benefit patients with chronic lung diseases other than COPD. There is substantial new evidence that pulmonary rehabilitation is beneficial for patients with COPD and other chronic lung diseases. Several areas of research provide opportunities for future research that can advance the field and make rehabilitative treatment available to many more eligible patients in need.