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Effect of Conservative vs Conventional #Oxygen Therapy on #Mortality Among Patients in an Intensive Care Unit
The Oxygen-ICU Randomized Clinical Trial
http://jama.jamanetwork.com/mobile/article.aspx?articleid=2565306
Conclusions and Relevance Among critically ill patients with an ICU length of stay of 72 hours or longer, a conservative protocol for oxygen therapy vs conventional therapy resulted in lower ICU mortality. These preliminary findings were based on unplanned early termination of the trial, and a larger multicenter trial is needed to evaluate the potential benefit of this approach.
The Oxygen-ICU Randomized Clinical Trial
http://jama.jamanetwork.com/mobile/article.aspx?articleid=2565306
Conclusions and Relevance Among critically ill patients with an ICU length of stay of 72 hours or longer, a conservative protocol for oxygen therapy vs conventional therapy resulted in lower ICU mortality. These preliminary findings were based on unplanned early termination of the trial, and a larger multicenter trial is needed to evaluate the potential benefit of this approach.
Jamanetwork
Conservative vs Conventional Oxygen and ICU Mortality
This randomized clinical trial compares a conservative oxygen protocol vs standard oxygen delivery on the outcomes of mortality, organ failure, and infection in adult patients admitted to a medical-surgical intensive care unit (ICU).
A Randomized Trial of Long-Term #Oxygen for #COPD with Moderate Desaturation https://lnkd.in/eCi-qyG In patients with stable COPD and resting or exercise-induced moderate desaturation, the prescription of long-term supplemental oxygen did not result in a longer time to death or first hospitalization than no long-term supplemental oxygen, nor did it provide sustained benefit with regard to any of the other measured outcomes
New England Journal of Medicine
A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation — NEJM
Original Article from The New England Journal of Medicine — A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation
Effect of Home Noninvasive #Ventilation With #Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute #COPD Exacerbation
A Randomized Clinical Trial http://jamanetwork.com/journals/jama/fullarticle/2627985 Importance Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death. The median time to readmission or death was 4.3 months (IQR, 1.3-13.8 months) in the home oxygen plus home NIV group vs 1.4 months (IQR, 0.5-3.9 months) in the home oxygen alone group, adjusted hazard ratio of 0.49 (95% CI, 0.31-0.77; P = .002). The 12-month risk of readmission or death was 63.4% in the home oxygen plus home NIV group vs 80.4% in the home oxygen alone group, absolute risk reduction of 17.0% (95% CI, 0.1%-34.0%). At 12 months, 16 patients had died in the home oxygen plus home NIV group vs 19 in the home oxygen alone group. Conclusions and Relevance Among patients with persistent hypercapnia following an acute exacerbation of COPD, adding home noninvasive ventilation to home oxygen therapy prolonged the time to readmission or death within 12 months.
A Randomized Clinical Trial http://jamanetwork.com/journals/jama/fullarticle/2627985 Importance Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death. The median time to readmission or death was 4.3 months (IQR, 1.3-13.8 months) in the home oxygen plus home NIV group vs 1.4 months (IQR, 0.5-3.9 months) in the home oxygen alone group, adjusted hazard ratio of 0.49 (95% CI, 0.31-0.77; P = .002). The 12-month risk of readmission or death was 63.4% in the home oxygen plus home NIV group vs 80.4% in the home oxygen alone group, absolute risk reduction of 17.0% (95% CI, 0.1%-34.0%). At 12 months, 16 patients had died in the home oxygen plus home NIV group vs 19 in the home oxygen alone group. Conclusions and Relevance Among patients with persistent hypercapnia following an acute exacerbation of COPD, adding home noninvasive ventilation to home oxygen therapy prolonged the time to readmission or death within 12 months.
Effect of Routine Low-Dose #Oxygen Supplementation on Death and Disability in Adults With Acute #Stroke
The Stroke Oxygen Study Randomized Clinical Trial
http://jamanetwork.com/journals/jama/article-abstract/2654819
Hypoxia is common in the first few days after acute stroke, is frequently intermittent, and is often undetected. Oxygen supplementation could prevent hypoxia and secondary neurological deterioration and thus has the potential to improve recovery A total of 8003 patients (4398 (55%) men; mean SD age, 72 13 years; median National Institutes of Health Stroke Scale score, 5; mean baseline oxygen saturation, 96.6%) were enrolled.
The primary outcome was available for 7677 (96%) participants. The unadjusted OR for a better outcome (calculated via ordinal logistic regression) was 0.97 (95% CI, 0.89 to 1.05; P = .47) for oxygen vs control, and the OR was 1.03 (95% CI, 0.93 to 1.13; P = .61) for continuous vs nocturnal oxygen. No subgroup could be identified that benefited from oxygen. At least 1 serious adverse event occurred in 348 (13.0%) participants in the continuous oxygen group, 294 (11.0%) in the nocturnal group, and 322 (12.1%) in the control group. No significant harms were identified.
Conclusions and Relevance Among nonhypoxic patients with acute stroke, the prophylactic use of low-dose oxygen supplementation did not reduce death or disability at 3 months. These findings do not support low-dose oxygen in this setting
The Stroke Oxygen Study Randomized Clinical Trial
http://jamanetwork.com/journals/jama/article-abstract/2654819
Hypoxia is common in the first few days after acute stroke, is frequently intermittent, and is often undetected. Oxygen supplementation could prevent hypoxia and secondary neurological deterioration and thus has the potential to improve recovery A total of 8003 patients (4398 (55%) men; mean SD age, 72 13 years; median National Institutes of Health Stroke Scale score, 5; mean baseline oxygen saturation, 96.6%) were enrolled.
The primary outcome was available for 7677 (96%) participants. The unadjusted OR for a better outcome (calculated via ordinal logistic regression) was 0.97 (95% CI, 0.89 to 1.05; P = .47) for oxygen vs control, and the OR was 1.03 (95% CI, 0.93 to 1.13; P = .61) for continuous vs nocturnal oxygen. No subgroup could be identified that benefited from oxygen. At least 1 serious adverse event occurred in 348 (13.0%) participants in the continuous oxygen group, 294 (11.0%) in the nocturnal group, and 322 (12.1%) in the control group. No significant harms were identified.
Conclusions and Relevance Among nonhypoxic patients with acute stroke, the prophylactic use of low-dose oxygen supplementation did not reduce death or disability at 3 months. These findings do not support low-dose oxygen in this setting
Jamanetwork
Oxygen Supplementation After Acute Stroke
Three months after acute stroke, this randomized clinical trial compares rates of death and disability among adult patients receiving continuous or nocturnal low-dose oxygen supplementation or control intervention (oxygen only if clinically indicated.
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Daily duration of long-term #oxygen therapy and risk of hospitalization in oxygen-dependent #COPD patients
https://www.dovepress.com/daily-duration-of-long-term-oxygen-therapy-and-risk-of-hospitalization-peer-reviewed-article-COPD
A total of 2,249 patients with COPD (59% women) were included. LTOT 24 h/d was prescribed to 539 (24%) and LTOT 15–16 h/d to 1,231 (55%) patients. During a median follow-up of 1.1 years (interquartile range, 0.6–2.1 years), 1,702 (76%) patients were hospitalized. No patient was lost to follow-up. The adjusted rate of all-cause hospitalization was similar between LTOT 24 and 15–16 h/d (subdistribution hazard ratio SHR 0.96; 95% CI 0.84–1.08), as was cause-specific hospitalizations analyzed for respiratory disease (SHR: 1.00; 95% CI: 0.86–1.17) and nonrespiratory disease (SHR: 0.92; 95% CI: 0.75–1.14).
Conclusion: LTOT prescribed for 24 h/d was not associated with decreased hospitalization rates compared with LTOT for 15–16 h/d in patients with oxygen-dependent COPD. The results should be validated in a randomized controlled trial.
Daily duration of long-term #oxygen therapy and risk of hospitalization in oxygen-dependent #COPD patients
https://www.dovepress.com/daily-duration-of-long-term-oxygen-therapy-and-risk-of-hospitalization-peer-reviewed-article-COPD
A total of 2,249 patients with COPD (59% women) were included. LTOT 24 h/d was prescribed to 539 (24%) and LTOT 15–16 h/d to 1,231 (55%) patients. During a median follow-up of 1.1 years (interquartile range, 0.6–2.1 years), 1,702 (76%) patients were hospitalized. No patient was lost to follow-up. The adjusted rate of all-cause hospitalization was similar between LTOT 24 and 15–16 h/d (subdistribution hazard ratio SHR 0.96; 95% CI 0.84–1.08), as was cause-specific hospitalizations analyzed for respiratory disease (SHR: 1.00; 95% CI: 0.86–1.17) and nonrespiratory disease (SHR: 0.92; 95% CI: 0.75–1.14).
Conclusion: LTOT prescribed for 24 h/d was not associated with decreased hospitalization rates compared with LTOT for 15–16 h/d in patients with oxygen-dependent COPD. The results should be validated in a randomized controlled trial.
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#Oxygen therapy for acutely ill medical patients: a clinical practice #guideline
https://www.bmj.com/content/363/bmj.k4169
What you need to know
It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation
A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital
For patients receiving oxygen therapy, aim for peripheral capillary oxygen saturation (SpO2) of ≤96% (strong recommendation)
For patients with acute myocardial infarction or stroke, do not initiate oxygen therapy in patients with SpO2 ≥90% (for ≥93% strong recommendation, for 90-92% weak recommendation)
A target SpO2 range of 90-94% seems reasonable for most patients and 88-92% for patients at risk of hypercapnic respiratory failure; use the minimum amount of oxygen necessary
#Oxygen therapy for acutely ill medical patients: a clinical practice #guideline
https://www.bmj.com/content/363/bmj.k4169
What you need to know
It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation
A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital
For patients receiving oxygen therapy, aim for peripheral capillary oxygen saturation (SpO2) of ≤96% (strong recommendation)
For patients with acute myocardial infarction or stroke, do not initiate oxygen therapy in patients with SpO2 ≥90% (for ≥93% strong recommendation, for 90-92% weak recommendation)
A target SpO2 range of 90-94% seems reasonable for most patients and 88-92% for patients at risk of hypercapnic respiratory failure; use the minimum amount of oxygen necessary
Randomized Trial of Nocturnal #Oxygen in Chronic #Obstructive Pulmonary Disease
https://2medical.news/2020/09/22/randomized-trial-of-nocturnal-oxygen-in-chronic-obstructive-pulmonary-disease/
Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain.. ..Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or …
https://2medical.news/2020/09/22/randomized-trial-of-nocturnal-oxygen-in-chronic-obstructive-pulmonary-disease/
Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain.. ..Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or …
Home #Oxygen Therapy for Adults with Chronic #Lung Disease. An Official American Thoracic Society Clinical Practice Guideline
https://2medical.news/2020/11/21/home-oxygen-therapy-for-adults-with-chronic-lung-disease-an-official-american-thoracic-society-clinical-practice-guideline/
Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel …
https://2medical.news/2020/11/21/home-oxygen-therapy-for-adults-with-chronic-lung-disease-an-official-american-thoracic-society-clinical-practice-guideline/
Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel …