The quandary of prehospital oxygen administration in chronic obstructive pulmonary disease - A review of the literature

Abstract

Introduction: Perpetual debate continues regarding the amount of oxygen that should delivered by paramedics to patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). A number of studies argue that providing excessive levels of oxygen in COPD patients results in hypercapnic respiratory failure. Despite the prevalence of COPD there continues to be a paucity of prehospital literature on this topic. Objective: To review and analyse the literature regarding prehospital administration of oxygen therapy in patients with COPD. Design: Literature review using a variety of medical databases including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL and PubMed. The following MeSH terms were used in the search: lung diseases, obstructive; emergency medical services; respiratory therapy. Results: Using exclusion and inclusion criteria a total of 9 papers were located. There is a lack of high quality evidence to adequately address the issue of oxygen prescription to COPD patients in the prehospital setting. It is recommended that oxygen flow is titrated in COPD patients to maintain SpO2 between 90-92%. Conclusions: There is a need for randomised controlled trials in the prehospital setting to address the issue regarding oxygen prescription for COPD patients. Oxygen can be titrated using pulse oximetry to minimize complications of hypoxia and the risk of hypercapnia from excessively high oxygen concentration.