High flow O2 and mortality in COPD

An Australian randomised controlled trial of pre-hospital oxygen therapy in COPD patients compared titrated oxygen therapy with high flow oxygen. The primary outcome was prehospital and in-hospital mortality.

Titrated oxygen treatment was delivered by nasal prongs to achieve arterial oxygen saturations between 88% and 92%, with concurrent bronchodilator treatment administered by a nebuliser driven by compressed air. High flow oxygen was 8-10 l/min administered by a non-rebreather face mask, with bronchodilators delivered by nebulisation with oxygen at flows of 6-8 l/min.
Titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory acidosis compared with high flow oxygen in acute exacerbations of chronic obstructive pulmonary disease. The authors claim: ‘For high flow oxygen treatment in patients with confirmed chronic obstructive pulmonary disease in the prehospital setting, the number needed to harm was 14; that is, for every 14 patients who are given high flow oxygen, one will die.

The authors did not report data on the in-hospital management of the patients.

Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial
BMJ. 2010 Oct 18;341:c5462

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