Implementation of a Titrated Oxygen Protocol in the Out-of-Hospital Setting

2014 ◽  
Vol 29 (4) ◽  
pp. 403-408 ◽  
Author(s):  
Nichole Bosson ◽  
Marianne Gausche-Hill ◽  
William Koenig
Keyword(s):  
Hospital Setting ◽  
Supplemental Oxygen ◽  
Therapeutic Agents ◽  
Chronic Obstructive ◽  
British Thoracic Society ◽  
Practical Application ◽  
Publication Type ◽  
Obstructive Pulmonary Disease ◽  
Postresuscitation Care ◽  
High Flow Oxygen

AbstractOxygen is one of the most frequently-used therapeutic agents in medicine and the most commonly administered drug by prehospital personnel. There is increasing evidence of harm with too much supplemental oxygen in certain conditions, including stroke, chronic obstructive pulmonary disease (COPD), neonatal resuscitations, and in postresuscitation care. Recent guidelines published by the British Thoracic Society (BTS) advocate titrated oxygen therapy, but these guidelines have not been widely adapted in the out-of-hospital setting where high-flow oxygen is the standard. This report is a description of the implementation of a titrated oxygen protocol in a large urban-suburban Emergency Medical Services (EMS) system and a discussion of the practical application of this out-of-hospital protocol.BossonN,Gausche-HillM,KoenigW.Implementation of a titrated oxygen protocol in the out-of-hospital setting.Prehosp Disaster Med.2014;28(4):1-6.

scholarly journals The effectiveness of supplemental oxygen during exercise training in patients with chronic obstructive pulmonary disease who show severe exercise-induced desaturation: a protocol for a meta-regression analysis and systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Shohei Kawachi ◽  
Shuhei Yamamoto ◽  
Kenichi Nishie ◽  
Takayoshi Yamaga ◽  
Manaka Shibuya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Exercise Tolerance ◽  
Supplemental Oxygen ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Severe Exercise ◽  
Meta Regression ◽  
Exercise Induced

Abstract Background Supplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO2 of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline. Methods We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline. Discussion One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events. Systematic review registration Registration number, UMIN000039960.

scholarly journals Lower lobe lung volume reduction surgery: a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Mohammed J Al-Jaghbeer ◽  
Umur Hatipoglu ◽  
Sid Murthy ◽  
Yvonne Meli ◽  
Atul C Mehta
Keyword(s):  
Lung Volume ◽  
Lower Lobe ◽  
Supplemental Oxygen ◽  
Volume Reduction ◽  
Chronic Obstructive ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease ◽  
Heterogeneous Distribution ◽  
Optimal Medical Management

ABSTRACT Lung volume reduction surgery (LVRS) is an option for select patients with advanced chronic obstructive pulmonary disease (COPD). Current guidelines recommend LVRS for patients with appropriate physiology and heterogeneous distribution of emphysema predominately involving upper lobes. We present an unusual case of a 72-year-old male with an advanced COPD who suffered with recurrent exacerbations despite optimal medical management. He underwent a two-stage bilateral lower lobe LVRS for heterogeneous lower lobe emphysema via video-assisted thoracoscopic (VATS) approach. This resulted in a significant subjective as well as objective improvement in his pulmonary functions, 6-min walk distance and subsequent discontinuation of supplemental oxygen.

Non-invasive ventilation

2021 ◽  
pp. 267-283
Author(s):  
Josep Masip ◽  
Kenneth Planas ◽  
Arantxa Mas
Keyword(s):  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Hospital Setting ◽  
Positive Pressure ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Support Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, immunocompromised or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure, bilevel pressure support ventilation and more recently, high flow nasal cannula. Whereas non-invasive pressure support ventilation requires a ventilator, the other two techniques are simpler and can be easily used in non-equipped areas by less experienced teams, including the pre-hospital setting. The success of non-invasive ventilation is related to an adequate timing, proper selection of patients and interfaces, close monitoring as well as the achievement of a good adaptation to patients’ demand.

Yoga Breathing Techniques (YBT) in Chronic Obstructive Pulmonary Disease (COPD):A Preliminary Study

2003 ◽  
Vol 13 (1) ◽  
pp. 51-54 ◽  
Author(s):  
P. Vedanthan
Keyword(s):  
Oxygen Supply ◽  
Vital Signs ◽  
Supplemental Oxygen ◽  
Chronic Obstructive ◽  
Relaxation Techniques ◽  
Obstructive Pulmonary Disease ◽  
Adjunct Treatment ◽  
Average Value ◽  
Breathing Exercises ◽  
Breathing Techniques

Yoga Breathing techniques (YBT) have been in vogue as an adjunct treatment in the management of asthma. The current study was done to determine the value of YBT in patients with COPD. Eleven patients (6 male, 5 female) in the age range 61–82 years (mean age 72) with an established diagnosis of COPD volunteered to participate in the study. Written consents were obtained prior to start of the study. All subjects were taught the YBT and relaxation techniques by a senior Yoga teacher. The procedure for YBT used in this group was modified to accommodate the limited physical capabilities of the participants due to their age as well as the severity of their COPD. The techniques involved breathing exercises with hand stretching, guided relaxation,sectional breathing, and meditation. All the participants received recorded audiotapes so that they could practice these techniques at home for a period of one week prior to the study. All the subjects were on continuous supplemental oxygen 1–3 liters per minute via nasal prongs. On the study day, baseline vital signs (blood pressure,pulse rate) were taken, a physical examination was done, and spirometry and oximetry were performed and readings recorded. The supplemental oxygen supply was stopped and subjects were asked to perform the YBT off oxygen. The subjects were closely watched and supervised by the Yoga teacher, as well as by the principal physician investigator, during this procedure. Continuous oximetry readings were taken and readings were recorded at baseline, 10 minutes, and 20 minutes during the performance of the YBT. Pre- and post-Yoga spirometry also was performed and recorded. All the subjects were requested to write down their impressions of the effect of YBT. Results: Oxygen saturation dropped to an average value of 87% (range: 82%–92%) immediately after the oxygen supply was discontinued. The oximetry values rose at 10 minutes to 92% and at 20 minutes to 94% during theYBT session on room air alone (without the use of supplemental oxygen). Ten out of 11 subjects felt subjectively better and relaxed overall. One subject could not tolerate being off oxygen, but still felt better subjectively during YBT. Spirometry values before and after YBT did not show any significant change. Conclusion:YBT seems to offer some benefit to patients with COPD and emphysema.

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