Patients treated with automatic oxygen administration had less dyspnea than patients treated with manual oxygen administration.
Studies have shown that patients with COPD who have been admitted to the hospital with exacerbated symptoms often benefit from the application of automated oxygen administration as opposed to manual nurse-administered oxygen administration. Physician’s Weekly interviewed Ejvind Frausing Hansen, MD, on this topic. Dr. Hansen and colleagues recently published their findings in the International Journal of Chronic Obstructive Pulmonary Disease.
Physician’s Weekly: Why did you feel this topic needed exploration?
Dr. Hansen: We know that automated oxygen administration is better than manual oxygen administration to keep the patient’s oxygen level in the blood at the right interval, which is important, as both too little and too much oxygen in the blood can be dangerous, especially for patients with COPD. However, we don’t know if this way of optimizing oxygen control relieves dyspnea, as dyspnea is a very complex sensation, and the oxygen level in the blood is only one of many mechanisms which can contribute to the sensation of dyspnea. For this reason, we decided to investigate if dyspnea was less pronounced in patients when they were treated with automatic oxygen administration than with manual, nurse-administered oxygen administration during hospitalization with an exacerbation of COPD.
What are the most important takeaway points from your study?
We found that patients treated with automatic oxygen administration had less dyspnea than patients treated with manual oxygen administration. In our study, we found an average reduction of 3.0 on the Multidimensional Dyspnea Profile, which means that patients treated with automated oxygen administration had a very substantial and clinically relevant reduction in dyspnea compared to patients on manually administered oxygen. All sensory dimensions of dyspnea were reduced by the intervention, whereas the emotional dimensions were unchanged, which could indicate that the mechanism for alleviating dyspnea was, in fact, providing better oxygen control during the intervention and not a reduction in the emotional dimension of dyspnea, due to the patient’s knowledge of being part of an active intervention (Table).
How can these findings be incorporated into practice?
We have increasing evidence of the importance of better oxygen control for patients with COPD, as we know the prognosis during hospitalization with an exacerbation of COPD is worse if the patients experience episodes with low or very high levels of oxygen in the blood. Now, we also know that patients experience less dyspnea if we control oxygen better during an admission. International guidelines have long emphasized the importance of keeping the oxygen levels in the blood within a certain range, but it is difficult to adhere to those guidelines with intermittent nurse-administered oxygen adjustments, so we should probably use technology to help on this issue. With automated oxygen administration, the oxygen level in the blood is measured continuously by pulse oximetry and thus adjustments are possible every second if needed. Our study calls for implementing automated oxygen administration during the admission of patients with an exacerbation of COPD, as it has the potential for improving the prognosis and alleviating dyspnea.
What would you like future research to be focused on?
Our study is to our knowledge the largest conducted on patients with an exacerbation of COPD. We have limited knowledge regarding the possibility of reducing the length of stay and time for weaning off oxygen supplementation with this technology, so future studies should focus on those issues as well as on the potential for reducing in-hospital mortality, but this will require larger studies.
