References
Oxygen titration therapy and hypercapnia risk in COPD
Abstract
Background:
Estimated to be the third leading cause of death in the UK by 2030, chronic obstructive pulmonary disease (COPD) is a common presenting complaint requiring an emergency ambulance. It is recognised that patients with COPD are at high risk of developing hypercapnia with the main theory of causality being high-flow oxygen therapy. Therefore, current guidelines recommend titrating oxygen therapy to maintain oxygen saturation percentage (SpO2) of 88–92% to reduce this risk.
Aim:
The aim of this review is to analyse literature concerning oxygen therapy in patients with COPD and their potential risk of hypercapnia.
Methods:
Extensive literature searches with strict parameters were carried out in electronic databases. After filtration of results, eight core articles were selected for analysis, from which three themes were identified as particular topics of interest.
Findings:
Critical analysis of the core articles confirmed the increased risk of hypercapnia in patients with COPD, but it is unclear if the cause is high-flow oxygen therapy, rate of alveolar ventilation or a specific COPD phenotype.
Conclusion:
Methods of reducing hypercapnia are limited in the prehospital setting with the only method transferable to paramedic practice being air nebulisation. Clinical compliance with study protocols and current national guidelines is low, both in prehospital and in-hospital environments.
Estimated to be the third leading cause of death by 2030 (World Health Organization (WHO), 2017), chronic obstructive pulmonary disease (COPD) is a common complaint requiring an emergency ambulance response (British Lung Foundation and British Thoracic Society (BTS), 2010).
While the condition is preventable and treatable, (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2017) it is a progressive disease and not fully reversible (National Institute for Health and Care Excellence (NICE), 2010). COPD is characterised by limited airflow and continuous respiratory symptoms. These symptoms are typically caused by exposure to toxic gases or particles, which lead to abnormalities in the airway and/or alveoli (GOLD, 2017).
The biggest cause of COPD is smoking, but occupational and environmental exposures, such as asbestos and biomass fuel, are also high-risk factors (NICE, 2010). A combination of disease to the small airways and parenchymal destruction contribute to the airflow limitations in patients with COPD, often evolving separately and developing at different rates (GOLD, 2017). Such conditions cause the small airways to narrow and the lung parenchyma to destruct, which leads to difficulties during expiration as a result of reduced ability of the airways to remain open (GOLD, 2017).
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