Guy's & St Thomas' NHS Foundation Trust, London, UK.
J Physiother. 2011;57(1):55. doi: 10.1016/S1836-9553(11)70008-X.
In patients with a suspected acute exacerbation of COPD, does titrated oxygen in the pre-hospital setting change mortality, length of hospital stay and blood gas measurements?
Cluster randomised controlled trial in which paramedics were allocated to deliver titrated or high flow oxygen. Randomisation sequence was concealed prior to allocation.
Ambulance service and emergency department in Hobart, Australia.
People who were: transported by ambulance to the emergency department, aged ≥35 years, breathless, and were thought to have COPD based on their acute symptoms, a patient-stated history of COPD, or a smoking history of > 10 pack-years. Randomisation of 64 paramedics allocated 32 to the titrated oxygen group and 30 to the high flow oxygen group. Over the study duration, 179 and 226 patients were allocated to the titrated and high flow oxygen groups, respectively.
Patients in both groups received basic support, nebulised bronchodilators, intravenous dexamethasone and, if necessary, intravenous or intramuscular salbutamol. In addition, the intervention group received titrated oxygen via nasal prongs, with the aim of maintaining arterial oxygen saturation, measured via a pulse oximeter (SpO(2)) between 88% and 92%. Nebulised therapy was delivered by compressed air. The control group received high flow oxygen (8 to 10 L/min) via a non-rebreather face mask. Nebulised therapy was delivered by compressed oxygen at 6 to 8 L/min.
The primary outcome was pre-and in-hospital mortality. Secondary outcomes were length of hospital stay and blood gas measurements.
The primary outcome was captured for all enrolled patients. According to the intention to treat (ITT) analysis, mortality in the intervention and control groups was 4% (n = 7) and 9% (n = 21), respectively. The relative risk was 0.42 (95% CI 0.20 to 0.89). Similar results were demonstrated when only those patients who had a physician-confirmed diagnosis of COPD were included in the analyses (mortality of 2%, n = 2, vs 9%, n = 11, and relative risk of 0.22, 95% CI 0.05 to 0.9]). The ITT analysis did not demonstrate between-group differences in the secondary outcomes.
In patients with a suspected acute exacerbation of COPD, using titrated oxygen to maintain SpO(2) between 88% and 92% reduced the risk of mortality by 58%. Physiotherapists working in acute care should strive to ensure that these patients are not treated with high-flow oxygen.
在疑似 COPD 急性加重的患者中，院前给予滴定氧治疗是否会改变死亡率、住院时间和血气测量结果？
对接受滴定或高流量氧治疗的护理人员进行聚类随机对照试验。在分配之前，对随机序列进行了隐藏。
澳大利亚霍巴特的救护车服务和急诊部。
符合以下条件的人：通过救护车送往急诊科，年龄≥35 岁，呼吸困难，根据其急性症状、患者自述的 COPD 病史或 10 包年以上的吸烟史，被认为患有 COPD。将 64 名护理人员随机分为滴定氧组和高流量氧组，每组 32 名。在研究期间，分别有 179 名和 226 名患者被分配到滴定氧组和高流量氧组。
两组患者均接受基础支持、雾化支气管扩张剂、静脉注射地塞米松，如果需要，还接受静脉或肌肉注射沙丁胺醇。此外，干预组通过鼻塞管接受滴定氧治疗，目的是通过脉搏血氧仪（SpO(2)）将动脉血氧饱和度维持在 88%至 92%之间。雾化治疗通过压缩空气输送。对照组通过非再呼吸面罩接受高流量氧气（8 至 10 L/min）。雾化治疗通过 6 至 8 L/min 的压缩氧气输送。
主要结局是住院前和住院期间的死亡率。次要结局是住院时间和血气测量结果。
所有入组患者均进行了主要结局评估。根据意向治疗（ITT）分析，干预组和对照组的死亡率分别为 4%（n = 7）和 9%（n = 21）。相对风险为 0.42（95%CI 0.20 至 0.89）。当仅将那些经医生确诊为 COPD 的患者纳入分析时，也得到了类似的结果（死亡率为 2%，n = 2，与 9%，n = 11，相对风险为 0.22，95%CI 0.05 至 0.9]）。ITT 分析未显示两组间次要结局存在差异。
在疑似 COPD 急性加重的患者中，使用滴定氧将 SpO(2)维持在 88%至 92%之间可使死亡率降低 58%。在急性护理中工作的物理治疗师应努力确保这些患者不接受高流量氧治疗。
