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lüll Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease Durrington HJ; Flubacher M; Ramsay CF; Howard LS; Harrison BDQJM 2005[Jul]; 98 (7): 499-504BACKGROUND: The Norfolk and Norwich University Hospital (NNUH) is situated in rural Norfolk, and ambulance journey times are often >30 min. Longer ambulance journeys could lead to a greater risk of hypercapnia, if inappropriately high concentrations of oxygen are given during an exacerbation of COPD. AIM: To investigate the effect of high concentration oxygen (HCO, FiO(2) > 0.28) on COPD patients, and the outcome of instituting a simple protocol to reduce such exposure. DESIGN: Retrospective audit. METHOD: An audit was conducted of all patients admitted with an exacerbation of COPD to the NNUH during the 2 months from 1 December 2001 to 31 January 2002 (n = 108). Results were shared with paramedics, and guidelines agreed for the initial provision of lower concentrations of oxygen (LCO, FiO(2) < or = 0.28). A second audit was conducted a year later between 1 December 2002 and 31 January 2003 (n = 103). RESULTS: HCO caused significant (p < 0.01) acidosis and inappropriately high PaO(2) and PaCO(2), compared to initial LCO therapy. There was a significantly increased complication rate during admission (p < 0.01) in those COPD patients receiving HCO compared to LCO, particularly when ambulance journeys exceeded 30 min. The second audit demonstrated a significant (p < 0.001) reduction in the number of patients initially receiving HCO, but the complication rate was unaltered. DISCUSSION: A simple intervention, such as providing paramedics with 28% Venturi masks, can reduce the number of COPD patients exposed to HCO. A randomized controlled trial is long overdue to establish whether HCO or LCO as initial management is associated with the most favourable prognosis in different hospital settings.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Ambulances[MESH]|Ambulatory Care/methods[MESH]|Carbon Dioxide/physiology[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Medical Audit/methods[MESH]|Middle Aged[MESH]|Oxygen Inhalation Therapy/adverse effects/*methods[MESH]|Oxygen/physiology[MESH]|Pulmonary Disease, Chronic Obstructive/*therapy[MESH]|Retrospective Studies[MESH]|Time Factors[MESH] |