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Oxygen Therapy for COPD Exacerbation: Higher Concentrations Lead to More Intubations FREE TO VIEW

Jacob Mathew; Ayham Aboeed; Suresh Kumar Manickavel; Muhammad Khan
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St. Joseph's Regional Medical Center, Paterson, NJ

Chest. 2014;146(4_MeetingAbstracts):41A. doi:10.1378/chest.1994762
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SESSION TITLE: COPD Diagnosis and Evaluation Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Oxygen therapy is provided to patients with an acute exacerbation of COPD,however,oxygen induced hypercapnea is a common side effect of such therapy especially in COPD patients who have chronic CO2 retention. In assessing this side effect,particularly regarding morbidity and mortality,one needs to take into consideration the concentration of oxygen therapy delivered by different delivery systems.The use of titrated oxygen systems (i.e.Venturi masks) has shown fewer instances of worsening respiratory acidosis,a lower requirement for assisted ventilation,and reduced mortality. In light of the above,we investigated the incidence of patients in our hospital system, who were found to have an acute exacerbation of COPD,and required invasive mechanical ventilation after having received treatment with oxygen in excess concentrations (i.e. >28%).

METHODS: A retrospective analysis was conducted on patients admitted between 2001-2014 to St. Joseph’s Health Care System in New Jersey,with diagnoses of COPD exacerbation and respiratory failure. Medical records were reviewed to ascertain if high concentrations of oxygen (FIO2>28%) were received prior to initiation of invasive mechanical ventilation. Data was subdivided into yearly incidence and method of oxygen delivery.

RESULTS: A total of 590 patient admissions were coded for diagnoses of COPD exacerbation and respiratory failure.Of these,approximately 100 were identified as instances in which high concentrations of supplemental oxygen may have played a role in the need for subsequent invasive mechanical ventilation. The most common methods of oxygen delivery in these cases were 100% non-rebreather masks and Bipap,followed by nasal cannula and Venturi-mask, respectively. A total of 21 subsequently died.

CONCLUSIONS: Identification of patients with COPD presenting with acute exacerbations is crucial in proper management. Adequate oxygen supplementation potentially prevents unwanted complications,the most concerning of which is invasive mechanical ventilation. In addition to the adverse effects to the patient,there is a protracted hospital course which has its own set of consequences,primarily cost. Better education and training to all those involved in administering oxygen therapy can help prevent such incidents.

CLINICAL IMPLICATIONS: The use of controlled oxygen delivery systems,such as the Venturi mask,in the setting of acute exacerbation of COPD,can potentially result in decreased number of intubations,decreased morbidity and mortality,as well as decreased hospital stay.

DISCLOSURE: The following authors have nothing to disclose: Jacob Mathew, Ayham Aboeed, Suresh Kumar Manickavel, Muhammad Khan

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