Pilcher Janine, Weatherall Mark, Perrin Kyle, Beasley Richard
Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand.
Expert Rev Respir Med. 2015 Jun;9(3):287-93. doi: 10.1586/17476348.2015.1016503. Epub 2015 May 15.
During the last decade, there have been major advances in knowledge of the effects of oxygen therapy in patients with acute exacerbations of chronic obstructive pulmonary disease. This includes a randomised controlled trial of oxygen therapy in the pre-hospital setting, which showed that high concentration oxygen therapy leads to a 2.4-fold increased risk of mortality compared with titrated oxygen therapy to maintain oxygen saturations (SpO2) within a target range of 88-92%. Professional guidelines now recommend the use of supplementary oxygen in acute exacerbations of chronic obstructive pulmonary disease only if the SpO2 is less than 88%, with titration to achieve an SpO2 of 88-92%, and the delivery of bronchodilators by air-driven nebulisation or metered dose inhaler with a spacer. The aim of this review is to provide an overview of the evidence base that underpins these recommendations. We suggest that their implementation will require important changes to current clinical practice in which there is an entrenched culture of the use of high concentration oxygen therapy.
在过去十年中，对于慢性阻塞性肺疾病急性加重患者氧疗效果的认识有了重大进展。这包括一项院前环境下氧疗的随机对照试验，该试验表明，与将氧饱和度（SpO2）维持在88 - 92%目标范围内的滴定氧疗相比，高浓度氧疗导致死亡风险增加2.4倍。目前专业指南建议，仅当SpO2低于88%时，才在慢性阻塞性肺疾病急性加重时使用补充氧气，并进行滴定以达到88 - 92%的SpO2，同时通过空气驱动雾化器或带储雾罐的定量吸入器给予支气管扩张剂。本综述的目的是概述支撑这些建议的证据基础。我们认为，实施这些建议将需要对当前临床实践进行重大改变，因为目前存在使用高浓度氧疗的根深蒂固的文化。
