Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease

 

Abstract

Background

Chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality in the developed world, is characterised by acute deterioration in symptoms. During these exacerbations, people are prone to developing alveolar hypoventilation, which may be contributed to by the administration of high inspired oxygen concentrations.

Objectives

The objective of the review was to determine the effect of different inspired oxygen concentrations ("high flow" compared to "controlled") in the pre-hospital setting on outcome for people with acute exacerbations of COPD.

Search methods

We searched the Cochrane Airways Group Specialised Register (CENTRAL), MEDLINE, EMBASE and CINAHL and reference lists of articles. We also contacted authors of identified RCTs for details of other relevant, published and unpublished studies. The most recent search was conducted in August 2008.

Selection criteria

Randomised controlled trials comparing oxygen therapy at different concentrations or oxygen therapy versus placebo in the pre-hospital setting for treatment of acute exacerbations of COPD were eligible.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data.

Main results

The search identified a total of 741 abstracts, of which 18 were selected as potentially relevant, only two of the 18 studies were randomised controlled trials and eligible for inclusion in the review, but were ongoing and had no data available for analysis.

Authors' conclusions

No relevant trials have been published to date, so there is no evidence to indicate whether different oxygen therapies in the pre-hospital setting have an effect on outcome for people with acute exacerbations of COPD. There is an urgent need for robust, well-designed randomised controlled trials to investigate the effect of oxygen therapies in the pre-hospital setting for people with acute exacerbations of COPD.

 

Plain language summary

Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease

People with Chronic obstructive pulmonary disease (COPD) are prone to sudden episodes where their symptoms become worse and oxygen levels may fall. Initial treatment during these episodes usually includes oxygen, but this may cause a rise in the carbon dioxide levels that can be dangerous. This review could not find any evidence to indicate the safest way to provide oxygen treatment in this circumstance.

 

摘要

背景

COPD急性惡化病患抵院前使用氧氣治療

COPD是已開發國家中一種高罹病率和死亡率的疾病。其特徵為症狀會急速惡化。在惡化狀況下，病患易引發肺泡換氣不足(alveolar hypoventilation)此可藉藉吸入高濃度氧氣來達到舒緩效果。

目標

本文獻回顧之目標在決定COPD急性惡化病患抵院前提供不同氧氣濃度(「高流量組」與「對照組」的比較)的成效。

搜尋策略

我們檢索Cochrane Airways Group Specialised Register(至2005年8月)、Cochrane Central Register of Controlled Trials (至2005年 Cochrane Library 第3期)、MEDLINE(1966年至2005年8月)、EMBASE(1980年至2005年第32週)及CINAHL(1982年至2005年第1週)等資料庫和試驗的參考資料，我們也與那些被確認的RCT作者連絡以獲取其他已發表或未發表之研究的細節資料。

選擇標準

那些以COPD急性惡化病患抵院前提供不同氧氣濃度治療或比較氧氣治療與安慰劑的隨機對照試驗都納入本研究中。

資料收集與分析

兩個審閱者獨立評估各試驗品質並萃取數據。

主要結論

結果確認741篇的摘要，其中18篇被認定可能與本研究有關，其中僅2篇是隨機性對照試驗且符合本研究的納入標準，但這兩篇研究仍持續進行中並無任何數據可供分析。

作者結論

至今仍無任何以發表的相關試驗，因此沒有證據指出急速惡化的COPD病患在抵院前使用不同氧氣濃度是否有效。當務之急是要進行良好設計的隨機性對照試驗以探討氧氣療法對急性惡化COPD病患抵院前的療效。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

COPD急性惡化病患抵院前以氧氣治療。COPD病患很容易突然發生症狀惡化且血氧降低地狀況。此時初步治療常包括使用氧氣，但此也增加二氧化碳含量增加，危及病患者的危險性。本文獻回顧並未發現任何證據說明在此情況下提供氧氣是安全的治療方式。