scholarly journals Oximetry neither to prescribe long-term oxygen therapy nor to screen for severe hypoxaemia

2021 ◽  
pp. 00272-2021
Author(s):  
Yves Lacasse ◽  
Sébastien Thériault ◽  
Benoît St-Pierre ◽  
Sarah Bernard ◽  
Frédéric Sériès ◽  
...  
Keyword(s):  
False Positive ◽  
Oxygen Therapy ◽  
Arterial Oxygen Saturation ◽  
False Negative ◽  
Arterial Oxygen ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Severe Hypoxaemia ◽  
Long Term Oxygen Therapy

Background and ObjectiveTranscutaneous pulse oximetry saturation (SpO2) is widely used to diagnose severe hypoxaemia and to prescribe long-term oxygen therapy (LTOT) in chronic obstructive pulmonary disease (COPD). This practice is not based on evidence. The primary objective of this study was to determine the accuracy (false positive and false negative rates) of oximetry for prescribing LTOT or for screening for severe hypoxaemia in patients with COPD.MethodsIn a cross-sectional study, we correlated arterial oxygen saturation (SaO2) and SpO2 in patients with COPD and moderate hypoxaemia (n=240), and calculated the false positive and false negative rates of SaO2 at the threshold of ≤88% to identify severe hypoxaemia (PaO2 ≤55 mmHg or PaO2 <60 mmHg) in 452 patients with COPD with moderate or severe hypoxaemia.ResultsThe correlation between SaO2 and SpO2 was only moderate (intra-class coefficient of correlation: 0.43; 95% confidence interval: 0.32–0.53). LTOT would be denied in 40% of truly hypoxemic patients on the basis of a SaO2 ˃ 88% (i.e., false negative result). Conversely, LTOT would be prescribed on the basis of a SaO2≤88% in 2% of patients who would not qualify for LTOT (i.e., false positive result). Using a screening threshold of≤92%, 5% of severely hypoxemic patients would not be referred for further evaluation.ConclusionsSeveral patients who qualify for LTOT would be denied treatment using a prescription threshold of saturation ≤88% or a screening threshold of ≤92%. Prescription of LTOT should be based on PaO2 measurement.

scholarly journals Improving home oxygen therapy in patients with interstitial lung diseases: application of a noninvasive ventilation device

2020 ◽  
Vol 14 ◽  
pp. 175346662096302
Author(s):  
Sandra Cuerpo ◽  
Maria Palomo ◽  
Fernanda Hernández-González ◽  
Joel Francesqui ◽  
Nuria Albacar ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Noninvasive Ventilation ◽  
Exercise Tolerance ◽  
Oxygen Therapy ◽  
Arterial Oxygen Saturation ◽  
Interstitial Lung Diseases ◽  
Arterial Oxygen ◽  
Chronic Obstructive ◽  
Long Term Oxygen Therapy

Background: Proper adjustment of arterial oxygen saturation (SaO2) during daily activities in patients with interstitial lung disease (ILD) requiring long-term oxygen therapy is challenging. Given the multifactorial nature of the limited exercise tolerance in patients with ILDs, the isolated use of oxygen therapy may not be enough. As demonstrated previously in patients with chronic obstructive pulmonary disease, the use of a noninvasive ventilation (NIV) device combined with oxygen therapy may prevent the falling of oxygen saturation during exercise, due to an improvement of the ventilation–perfusion ratio and a reduction of the respiratory work, thus enhancing exercise tolerance. We sought to assess in patients diagnosed with ILD who are in need of oxygen therapy, the effect of associating an NIV to improve oxygen parameters and the distance covered during the 6 min walking test (6MWT). Methods: We conducted a prospective observational study in patients with ILDs. After a clinical characterization, we performed a 6MWT in two different situations: using a portable oxygen concentrator with the regular flow used by the patient during their daily life activities and afterwards adding the additional support of a NIV. The oxygen saturation parameters were registered with a portable oximeter. Results: We included 16 patients with different ILDs who have oxygen therapy prescribed. The use of NIV associated with oxygen therapy in comparison with the use of oxygen therapy alone showed an increase of the average SaO2 [91% (88–93) versus 88% (86–90%); p = 0.0005] and a decrease in the percentage of time with oxygen saturation <90%: 36% (6–56%) versus 58% (36–77%); p < 0.0001. There were no changes in the 6MWT distance: 307 m (222–419 m) versus 316 m (228–425 m); p = 0.10. Conclusions: In our study the use of a NIV system associated with long-term oxygen therapy during exercise showed beneficial effects, especially improvement of oxygen saturation. The reviews of this paper are available via the supplemental material section.

scholarly journals Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

2016 ◽  
Vol 73 (1) ◽  
Author(s):  
A. Corrado ◽  
T. Renda ◽  
S. Bertini
Keyword(s):  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Future Research ◽  
Chronic Obstructive ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Copd Patients ◽  
Number Of Patients ◽  
Long Term Oxygen Therapy

Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO255%. In fact no evidence supports the use of LTOT in COPD patients with moderate hypoxemia (55&lt;PaO2&lt;65 mmHg), and in those with decreased oxygen saturation (SO2&lt;90%) during exercise or sleep. Furthermore, it is generally accepted without evidence that LTOT in clinical practice is warranted in other forms of chronic respiratory failure not due to COPD when arterial blood gas criteria match those established for COPD patients. The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.

scholarly journals Adherence to long-term oxygen therapy in patients with chronic obstructive pulmonary disease

2018 ◽  
Vol 16 ◽  
pp. 147997231876772 ◽  
Author(s):  
Amélie Gauthier ◽  
Sarah Bernard ◽  
Emmanuelle Bernard ◽  
Serge Simard ◽  
François Maltais ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Oxygen Therapy ◽  
Primary Objective ◽  
Chronic Obstructive ◽  
Oxygen Utilization ◽  
Obstructive Pulmonary Disease ◽  
Daily Exposure ◽  
Long Term Oxygen Therapy

Long-term oxygen therapy (LTOT) has beneficial effects on survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia at rest. Two landmark trials suggested that these benefits depend on the time of exposure to oxygen. Patients are usually prescribed LTOT for at least 15–18 hours/day. The primary objective of this study was to determine the average daily exposure to supplemental oxygen in patients with severely hypoxemic COPD who were newly prescribed LTOT and the proportion of patients who were adherent to their prescription. The secondary objective was to identify predictors of compliance to LTOT. We performed a retrospective observational study of patients newly registered in a regional home oxygen program in Quebec, Canada, between July 1, 2013, and December 31, 2014. Daily exposure to oxygen was objectively measured from the concentrator’s counter clock. From 196 patients registered in the program during the study period, 115 contributed to the analysis. Most patients ( n = 84; 73%) were prescribed oxygen for ≥18 hours/day. Overall, the 115 patients were exposed to home oxygen for 17.8 hours/day; 60% of the patients were compliant according to our definition. Increasing age and ambulatory oxygen utilization predicted adherence to oxygen therapy. Adherence to home oxygen therapy is suboptimal. Behavioral and psychological interventions to improve compliance to LTOT should be investigated.

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