Effect of supplemental oxygen on hypercapnia in patients with stable chronic obstructive pulmonary disease, in Bogotá, Colombia

Size: px
Start display at page:

Download "Effect of supplemental oxygen on hypercapnia in patients with stable chronic obstructive pulmonary disease, in Bogotá, Colombia"

Transcription

1 Pneumologia Effect of supplemental oxygen on hypercapnia in patients with stable chronic obstructive pulmonary disease, in Bogotá, Colombia Efectul oxigenului suplimentar asupra hipercapniei la pacienții cu bronhopneumopatie cronică obstructivă stabilă în Bogotá, Columbia Abstract Introduction. The oxygen administration in COPD patients at sea level increases PaCO 2 ; above sea level this behavior is unknown. The objective of this study is to describe the difference between PaCO 2 levels in patients with stable COPD after the administration of supplemental FiO 2 of 28% and 50% at an altitude of 2,600 meters above sea level. Method. Randomized controlled crossover trial, involving severe COPD patients with baseline PaCO 2 >37 mmhg, with the administration of FiO 2 of 28% and 50% in two different days, with the measurement of arterial blood gases before and 30 minutes after the exposure. Results. Twenty-two patients were evaluated, the mean FEV1 was 41% of the predicted (SD=7.17). A significant increase in the PaCO 2 of 2.16 mmhg (IC 95%; ) with FiO 2 of 50% versus 28% compared to baseline values, p=0.025, was found, the ph decreased with 0.02 (95% CI; ), p= No period of interaction effect was detected. Conclusions. The administration of FiO 2 of 50% versus 28% in severe stable COPD patients with baseline PaCO 2 >37 mmhg at an altitude above 2,600 m produces an increase in PaCO 2 and a decrease in ph that achieved statistical significance. Caution is recommended when treating hypercapnic COPD patients with oxygen. Keywords: altitude, carbon dioxide, oximetry, chronic obstructive pulmonary disease Rezumat Introducere. Administrarea de oxigen pacienților cu BPOC la nivelul mării este urmată de creșterea PaCO 2 ; deasupra nivelului mării efectele sunt însă necunoscute. Obiectivul acestui studiu este să descrie diferențele între nivelurile PaCO 2 la pacienți cu BPOC stabil după administrare de oxigen suplimentar la FiO 2 de 28% și 50% la o altitudine de 2600 de metri deasupra nivelului mării. Metodă. Este un studiu randomizat controlat crossover, implicând pacienți cu BPOC sever cu PaCO 2 bazal mai mare de 37 mmhg, cărora li s-a administrat oxigen la FiO 2 de 28% și 50% în două zile diferite, cu determinarea gazometriei arteriale înainte și la 30 de minute după administrare. Rezultate. Au fost evaluați 22 de pacienți, valoarea medie a FEV1 a fost de 41% din prezis (SD=7,17). S-a observat o creștere semnificativă a PaCO 2 de 2,16 mmhg (IC 95%; 0,42-3,91), cu FiO 2 de 50% versus 28% raportat la valorile bazale, cu o valoare p=0,025, iar ph a scăzut cu 0,02 (IC 95%; -0,03-0,004), p=0,015. Nu a fost detectată nicio perioadă de efect de interacțiune. Concluzii. Administrarea de FiO 2 de 50% vs. 28% pacienților cu BPOC sever stabil cu PaCO 2 bazal >37 mmhg la o altitudine de peste 2600 m produce o creștere a PaCO 2 și o scădere a ph-ului, cu semnificație statistică. Se recomandă deci prudență când li se administrează oxigen pacienților hipercapnici cu BPOC. Cuvinte-cheie: altitudine, dioxid de carbon, oximetrie, boală pulmonară obstructivă cronică Juan José Duque 1, Hernán Darío Aguirre 2, Jaime Alvarado 3, Alirio Bastidas Goyes 4, Daniel Martin Arsanios 5 1. Internist Medical University of La Sabana, Chia, Colombia. 2. Internist and Clinical Epidemiologist (c), Clínica Bolivariana / Fundación Instituto Colombiano de Neurología / General Hospital of Medellín, Colombia 3. Pulmonologist, IPS Clinical Comprehensive Care Programs S.A.S., Bogotá, Colombia. 4. Pulmonologist and Clinical Epidemiologist, La Sabana University Clinic, Chía, Colombia 5. La Sabana University Physician Corresponding author: Alirio Bastidas, MD, MSc. unisabana.edu.co Introduction Chronic obstructive pulmonary disease (COPD) is the fourth cause of mortality worldwide. It is a disease with increasing prevalence, that generates high social and economic costs (1,2). For decades, the treatment with supplemental oxygen has been one of the pillars of management in patients with severe COPD; in addition to offering improvement in symptoms, it is one of the few therapeutic measures that when used correctly, changes outcomes in mortality. However, it is known that in different environments (laboratory, hospital and prehospital), oxygen use at high flows in patients with COPD considered CO 2 retainers, generally with PaCO 2 of more than 45 mmhg can generate physiological changes associated with a greater number of complications and fatal outcomes (3-5). An increase in arterial oxygen pressure (PaCO 2 ) is inversely proportional to the ph value; in patients with COPD CO 2 retainers, the use of high O 2 substitutions generates inhibition of the respiratory stimulus (6-8) and also to some extent alterations of the ventilation-perfusion (VQ) ratio (3). In studies carried out at high altitude, the PaCO 2 values considered as normal vary in comparison with the values considered normal at sea level; they can be seen at 2,600 meters above sea level, in Bogotá, Colombia; but also, the mean PaCO 2 has been variable in different studies, ranging from 29 to 36 mmhg, and the normal ranges of PaCO 2 go from 28.3 to 38.7 mmhg in men and from 26.3 to 39.8 in women. This variability in the findings has made it difficult to interpret the expected values compared to PaCO 2 when exposure to O 2 substitution is performed (8,9). The standard hospital and pre-hospital COPD treatment includes oxygen that can be administered in different ways, being able to provide different inspired fractions of oxygen, thus generating different changes in PaO 2 pressures in addition to PaCO 2, changes that are appreciable in heights, but the normal value of these changes is still not clear, nor is the magnitude of change expected for the different fractions of O 2 (10,11). The administration of high inspired fractions of oxygen from 50% to 100% in acute form in patients with hypoventila- 135

2 tion (CO 2 retainers) significantly worsens hypercapnia when compared to smaller fractions (3). However, the effect of oxygen and the levels of PaCO 2 on which this type of response can be generated at altitudes above 1,600 m a.s.l. and especially at high altitude (2,500-3,500 m a.s.l.) has been minimally studied, so that the ventilatory and oxygenation changes in these patients could reorient therapeutic behavior (12,13). It is feasible that the physiological responses that occur with the change in altitude influence in a different way COPD patients who are CO 2 retainers and who live at high altitude, even in clinically stable conditions (10-12). The aim of this study was to describe the change in PaCO 2 levels in patients with stable COPD (absence of exacerbation or symptoms that have led to a change in management in the last month) and with PaCO 2 considered high at high altitude (2,600 m a.s.l.), when supplemental oxygen is administered at 28% and 50% flows after 30 minutes. Materials and method Design, measurements and subjects A randomized crossover trial was conducted in patients with stable COPD who had PaCO 2 levels greater than 37 mmhg, from places with heights of approximately 2,600 m a.s.l., during the months of October and November Stable COPD patients were defined as patients with a postbronchodilator FEV1/FVC ratio of less than 70, who had not had exacerbations or symptoms of exacerbation of the disease for at least four weeks before entering the study. Hypercapnia was defined as PCO 2 greater than or equal to 37 mmhg, value based on data for Bogotá (14). The sample size was calculated for a 2x2 crossover clinical trial with a quantitative outcome based on previous studies in subjects at sea level and in Bogotá, where the standard deviation of PaCO 2 levels with 21% oxygen was 1.27 mmhg with 50% oxygen of 1.16 mm Hg, rho of 0.6 and a clinically significant expected difference of 4 mm Hg in PaCO 2, requiring 22 subjects in total to achieve a minimum power of 80% and alpha error of Inclusion criteria Patients older than 40 years were included, with COPD defined as FEV1/FVC less than 70 in addition with a FEV1 less than 50 ml post-bronchodilator in spirometry performed in a period of less than 2 years and reviewed and evaluated by an external pulmonologist in the group of investigators with arterial gases by clinical history (with report of the gasometrical report) that would show a PaCO 2 greater than 37 mmhg to the ambient air and that resided in places with height of 2,600 meters above sea level for a time not less than a month and that they voluntarily accept to participate in the study, as well as being able to understand and sign the informed consent. Exclusion criteria Patients with increased dyspnea, cough or sputum production or sputum purulence in the last month, obesity (body mass index greater than 30), diagnosis of other causes of hypoventilation or increased PaCO 2 (neuromuscular diseases), acute respiratory infections in the last month, arteriovenous fistulas, presence of contraindications for the performance of gas sampling in the radial artery (bilateral positive Allen test, infection or vascular disease at the puncture site), the presence of coagulation disorders or on anticoagulant therapy, patients with permanent home oxygen (more than 18 hours a day), change in clinical condition in the study washout period, presence of other pulmonary diseases (diffuse interstitial lung disease), advanced heart failure, sleep apnea in treatment with positive pressure devices and the use of drugs with hypoventilation potential due to central nervous system depression. Data collection The preliminary selection of patients was performed with the database of the IPS Clinical Comprehensive Care Programs S.A.S., reviewing the histories to evaluate inclusion and exclusion criteria. In the subjects considered as potential, the spirometry test was evaluated by a pulmonologist of the study team without fulfilling selection criteria. The patients were invited to participate in the study and two appointments were scheduled for the execution of the study in which it was proceeded to administer oxygen with inspired fraction of 28% or 50%. Recording of demographic data and a verification of inclusion and exclusion criteria were performed with the data provided by the patient in direct questioning at the first visit and in addition to a second verification of the data of his/her previous clinical history. At the second visit, the absence of a recent exacerbation (one month) was verified and oxygen was administered to the fraction inspired according to the previous randomization, which was generated by an epidemiologist unrelated to the medical review processes, application of inspired fractions of O 2, taking samples and typing and keeping information. The data was transcribed into a data collection format created by the researchers and the gas results were archived together with the format. The results were transcribed from the collection forms filled out by the researchers to an Excel spreadsheet, with subsequent revision and verification of the data from the Excel sheet with the original source by another researcher. In the case of disparate data, a new review of gasometrical reports and correction of these values was generated, prior to the start of the statistical process. The validity of the PaCO 2 values of the arterial gases was verified by means of the Kassirer-Bleich formula (15). Measurement The gasometrical values were obtained by means of direct arterial puncture with heparinized syringe for arterial gases, after the negativity of the Allen test was verified. The procedure was carried out by two professionals in respiratory therapy contracted exclusively for this study. The reports were generated by a Cobas B221 blood gas analysis team (Roche), using only reliable samples and discarding the coagulated ones. Functional test of the Venturi systems of 28% and 50% was carried out in the Exercise Physiology System Quick Setup gas analyzer of La Sabana Clinic, verifying the inspired fraction of O 2 that these administer. Exposure Before starting the procedure, the patient was expected to have a minimum of 30 minutes of physical rest and then proceed to basal arterial gas sampling with an inspired fraction of oxygen of 21%, after which the fraction of oxygen was administered for 30 minutes. It was assigned according to the previous randomization to then measure a new arterial gas value after exposure; all the arterial gas samples were transported immediately to the processing center of the clinical laboratory Dinámica SA hired for the study. 136

3 Pneumologia Statistical analysis Initially, two data analysis were performed using Excel spreadsheet to evaluate data agreement and later in the statistical program SPSS (version 20 IBM ) licensed by the Universidad de La Sabana. A description of the data obtained with summary measures was made, after verification of statistical normality (Kolmogórov-Smirnov and Shapiro Wilk). Afterwards, the averages were compared by means of student T for paired tests, analysis of treatment effect, period and interaction according to the parameters established for cross-clinical trials, and a statistically significant p<0.05 was considered. Ethical considerations The protocol was evaluated by the research subcommittee of the University of La Sabana to evaluate its methodological rigor to be subsequently evaluated and approved by the Ethics Committee of the University of La Sabana. The protocol adhered to the declarations of Helsinki and the Colombian legislation for the development of patient research. The informed consent of each one of the studied individuals was obtained, keeping the reservation of the same ones, being used only for its identification a sequential number in the study. There were civil liability policies for the researchers before the start of the study. Results During the study period, 276 clinical records of patients with COPD and spirometry inclusion criteria were evaluated; of these, 105 had gasometrical criteria and no exclusion criteria, so they were contacted. Of these, 63 answered the telephone call, 20 did not agree to participate in the study, eight were excluded due to residence at a height of less than 2,600 meters, seven did not attend appointment number one, three were excluded on the first date due to obesity, three patients did not attend visit number two, so finally we had an analyzable sample of 22 patients who met the previously described criteria and thus achieved all the activities and measures proposed (Figure 1). The average age was 64 years old, with an equal proportion in gender and average body mass index of The baseline values of spirometry and prior arterial blood gases are shown in Table 1. The change in gas values between the inspired fraction of oxygen (FiO 2 ) of 21% and the FiO 2 of 28% and 50% are shown in Tables 2, 3 and 4. There was a statistical increase in PaCO 2, with a difference of 2.16 mmhg (95% CI; ; p=0.025); a difference in ph was also observed, of (95% CI; to ; p=0.015), in PaO 2 of 23.5 (95% CI; ; p<0.001). No differences were observed with the treatment of different inspired fractions of oxygen in HCO 3 =0.25 mmhg (95% CI; to 1.12; p=0.578), nor in the excess of base (95% CI; to 0.90; p=0.97). The rho between PaCO 2 with FIO 2 28% and FIO 2 50% was The analysis of period and interaction did not present differences in any of the analyzed variables (Table 5) and the basal gases of both doses were similar. The difference in PaCO 2 between FIO 2 50% and FIO 2 28% did not reach the threshold determined as clinically significant at 4 mmhg. 276 patients with COPD and spirometry 105 patients met gasometric criteria 63 patients answered the phone call 43 patients interested in participating 35 patients scheduled to 28 patients attended 25 patients scheduled to appointment 2 22 patients completed the study 171 patients without gasometric criteria 42 patients did not answer phone call 20 patients not interested in participating 8 patients did not live in the surroundings of Bogotá 7 patients did not attend 3 patients with BMI >30 3 patients did not attend appointment 2 Figure 1. Flowchart of patient selection and collection Discussion In this study it was found that the administration of oxygen to inspired fractions at 50% generated a greater increase in PaCO 2 levels when compared with the changes generated with a fraction inspired at 28%. These findings are similar to those found in studies in patients with COPD and alveolar hypoventilation, where administrations of high oxygen flows are associated with an increase in PaCO 2 levels. In the pre hospital setting, patients with COPD exacerbation managed with high oxygen fractions have an increase in unfavorable outcomes associated with the development of respiratory acidosis and increased mortality (9,16,17). Changes in PaCO 2 levels related to severe physiological alterations have been recorded above 10 mmhg, the increase of these values can be related to cerebral vasoconstriction and sensorial alterations and CO 2 intoxication. However, changes above 4 mmhg may be associated with some physiological changes (18). In this study, a statistically significant elevation in PaCO 2 levels was found between the treatments, although the differ- 137

4 Table 1 Characteristics of the population Table 2 Arterial gases with oxygen administration n=22 Age 64.7 ± 10.5 BMI 24.5 ± 3.96 Pulmonary function FEV1/CVF (%) ± VEF1 (%) 41 ± 7.17 Diagnostic spirometry (pattern) (%) Mixed 63 Obstructive 36 Severity (%) Severe 90.9 Very severe 9.1 Basal arterial gases FIO 2 21 % ph 7.39 ± pco 2 mmhg 42.6 ± 4.07 po 2 mmhg 45.8 ± 6.43 SO 2 % 80.3 ± 6.57 HCO 3 mmhg x 26 ± 1.58 BE* mmol/l x 1.2 ± 1.5 Table 3 FIO 2 21%* FIO 2 28% FIO 2 50% n=22 n=22 n=22 ph 7.39 ± ± ± pco 2 mm Hg ± ± ± 5.54 po 2 mm Hg ± ± ± 21.9 SO 2 % ± ± ± 5.2 HCO3 x(ds) ± ± ± 2.46 BE** (mmol/l) ± ± ± 2.41 * Average basal in both visits,** BE: excess base x (DS) Difference of averages of basal gases in each parameter ph PCO 2 PO 2 SaO 2 HCO 3 BE* 0.01± ± ± ± ± ±1.89 Table 4 Changes in gasometrical values with inspired oxygen fractions FIO % FIO % X ± ds 95% CI X ± ds 95% CI ph pco 2 mm Hg po 2 mmhg SO 2 % HCO 3 mmhg BE* mmol/l Table 5 Results of oxygen treatment in gasometrical values Treatment effect Period effect Interaction effect Δ50-28* 95% CI P value*** P value P value ph pco 2 mmhg po 2 mmhg < SO 2 % HCO 3 mmhg BE** mmol/l * Δ50-28: Difference between treatment with FIO 2 50% and FIO 2 28%; ** BE: excess base; *** Statistically significant: p 0.05 ence of 4 mmhg assumed to be clinically significant was not reached, possibly due to the relatively low FiO 2 used, since other studies found greater changes in the PaCO 2 when administering FIO 2 at 75% and 100% in similar periods of time (19,20). The ph values also had statistical changes; however, the value of their change is low to be considered of any clinical implication. As expected, PaO 2 and SO 2 increased with both treatments. However, the difference between the oxygen saturation obtained with FIO 2 at 50% and with FIO 2 28% does not have a great difference, which means that high concentrations of oxygen are not required to significantly improve SO 2 in patients with severe and stable COPD. It is also observed that there are great changes in the levels of PaO 2, even in some subjects it is appreciated until hyperoxemia, whose long-term results have not shown differences with the normoxemic patients (21-23). 138

5 Pneumologia This is one of the first studies performed at an altitude of 2,600 meters above sea level, where the response to oxygen of patients with COPD is evaluated from values lower than those usually used at sea level, where the average PaCO 2 is usually higher than 45 mmhg for this type of patients. However, the value over which patients were chosen for study entry is at the upper limit of the PaCO 2 reported value for this altitude (9). This fact may eventually explain the entry of some study subjects who present a normal hypocapnic response to the administration of oxygen, but it is also clear that subjects with values less than 45 mmhg have an abnormal hypercapnic response to oxygen administration, which suggests that in patients with severe and high altitude COPD, abnormal responses to oxygen administration can be obtained with baseline PaCO 2 values of less than 45 mmhg. In the patient with COPD, hypercapnia is initially attributed to changes in the respiratory centers of the central nervous system. Patients with COPD gradually retain PaCO 2, which leads to a diminished ventilatory response of the respiratory centers to hypercapnia. In these subjects, the ventilatory stimulus is given by the low levels of PaO2; if the levels in the oxygenation decrease, then the respiratory center is stimulated. However, if the concentrations are high, the response decreases, which explains the hypercapnia and the risk of clinical deterioration and CO 2 poisoning (6,23). With time, more importance has been given to pulmonary physiological changes, where the imbalance of the V/Q ratio and specifically to the reversion of hypoxic vasoconstriction increase the ventilation of the dead space, by definition incapable of gas exchange that contributes to the accumulation in blood of CO 2. Another factor is the Haldane effect, where non-oxygenated hemoglobin is much more associated with CO 2 than oxygenated hemoglobin, which means that oxygen administration releases that CO 2 previously bound to hemoglobin and increases PaCO 2 (3,20,24). The decrease of central origin of ventilation minute is, generally, transient and PaCO 2 continues to increase despite the recovery of it approximately after 20 minutes of oxygen administration, which reinforces the influence of the other two factors such as predominant in hypercapnia in COPD (3). Among the strengths of the study are the correct and exhaustive selection of patients, in addition to the crossed design that decreased the presence of confounding factors and variability. Also, the adequate processing and handling of the samples to guarantee a good quality of the data. Among the weaknesses is the single arterial blood gas sampling on treatment administration, which can be affected by the variability that a single sampling could show. On the other hand, the results can only be extrapolated to patients in a similar condition, without being able to generalize to patients with not so severe or exacerbated COPD, where physiological changes may be greater; nevertheless, a highly prevalent problem is addressed regarding the altitude, where patients with stable severe COPD will increase. Conclusion The administration of inspired fractions of O 2 at 50% versus 28% in patients with severe stable COPD with baseline PaCO 2 values greater than 37 mmhg at an altitude of 2,600 meters above sea level generates acute changes in PaCO 2, ph and po 2, although achieve the threshold level of change in the pco 2 established as clinically significant. n References 1. Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P, et al. Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study). Chest Feb; 133(2): Vogelmeier CF, Criner GJ, Martínez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Arch Bronconeumol Mar; 53(3): Abdo WF, Heunks LMA. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care Oct 29; 16(5): Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ Oct 18; 341:c Plant PK, Owen JL, Elliott MW. One year period prevalence study of respiratory acidosis in acute exacerbations of COPD: implications for the provision of non-invasive ventilation and oxygen administration. Thorax Jul; 55(7): Davies CE, Mackinnon J. Neurological effects of oxygen in chronic cor pulmonale. Lancet (London, England) Nov 12; 2(6585):883 5, illust. 7. Donald K, Simpson T, Mcmichael J LB. Neurological Effects of Oxygen. Lancet. 1949; 254(6588): Lasso J. Interpretation of arterial blood gases in Bogota (2640 meters above sea level) based on the SiggaardAndersen nomogram A proposal for simplifying and unifying reading. Rev Colomb Neumol. 2014; 26(1): Maldonado D, Gonzalez, Garcia M, Barrero M, Casas A TC. Reference Values For Arterial Blood Gases At An Altitude Of 2640 Meters. C76. Available from: Penaloza D, Arias-Stella J. The heart and pulmonary circulation at high altitudes: healthy highlanders and chronic mountain sickness. Circulation Mar 6; 115(9): Naeije R. Physiological adaptation of the cardiovascular system to high altitude. Prog Cardiovasc Dis. 2010; 52(6): Vogel JH, McNamara DG, Hallman G, Rosenberg H, Jamieson G, McCrady JD. Effects of mild chronic hypoxia on the pulmonary circulation in calves with reactive pulmonary hypertension. Circ Res Nov; 21(5): Durrington HJ, Flubacher M, Ramsay CF, Howard LSGE, Harrison BDW. Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease. QJM Jul; 98(7): O, Barrero M, Casas A, Torres-Duque CA, Maldonado D, Gonzalez-Garcia M, et al. Reference values for arterial blood gases at an altitude of 2640 meters. In: C76 Exercise, Hypoxia, and Altitude. American Thoracic Society. 2013; p. A4852 A4852. (American Thoracic Society International Conference Abstracts). 15. Kassirer JP, Bleich HL. Rapid estimation of plasma carbon dioxide tension from ph and total carbon dioxide content. N Engl J Med May 20; 272: DeGaute JP, Domenighetti G, Naeije R, Vincent JL, Treyvaud D, Perret C. Oxygen delivery in acute exacerbation of chronic obstructive pulmonary disease. Effects of controlled oxygen therapy. Am Rev Respir Dis Jul; 124(1): Wijesinghe M, Perrin K, Healy B, Hart K, Clay J, Weatherall M, et al. Prehospital oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease. Intern Med J Aug; 41(8): Guais A, Brand G, Jacquot L, Karrer M, Dukan S, Grévillot G, et al. Toxicity of carbon dioxide: a review. Chem Res Toxicol Dec 19; 24(12): Aubier M, Murciano D, Milic-Emili J, Touaty E, Daghfous J, Pariente R, et al. Effects of the administration of O 2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev Respir Dis Nov; 122(5): Crossley DJ, McGuire GP, Barrow PM, Houston PL. Influence of inspired oxygen concentration on deadspace, respiratory drive, and PaCO 2 in intubated patients with chronic obstructive pulmonary disease. Crit Care Med Sep; 25(9): Moore RP, Berlowitz DJ, Denehy L, Pretto JJ, Brazzale DJ, Sharpe K, et al. A randomised trial of domiciliary, ambulatory oxygen in patients with COPD and dyspnoea but without resting hypoxaemia. Thorax Jan; 66(1): Bradley JM, O Neill B. Short-term ambulatory oxygen for chronic obstructive pulmonary disease. Cochrane database Syst Rev Oct 19; (4):CD Robinson TD, Freiberg DB, Regnis JA, Young IH. The role of hypoventilation and ventilation-perfusion redistribution in oxygen-induced hypercapnia during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med May; 161(5): Hanson CW, Marshall BE, Frasch HF, Marshall C. Causes of hypercarbia with oxygen therapy in patients with chronic obstructive pulmonary disease. Crit Care Med Jan; 24(1):

Journal of Emergency Primary Health Care (JEPHC), Vol. 6, Issue 1, 2008 CLINICAL PRACTICE. Article

Journal of Emergency Primary Health Care (JEPHC), Vol. 6, Issue 1, 2008 CLINICAL PRACTICE. Article ISSN 1447-4999 CLINICAL PRACTICE Article 990280 The quandary of prehospital oxygen administration in chronic obstructive pulmonary disease - a review of the literature Elizabeth Perry, BPhysio, BEmergHealth(Paramedic)

More information

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D.

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D. Pilbeam: Mechanical Ventilation, 4 th Edition Test Bank Chapter 1: Oxygenation and Acid-Base Evaluation MULTIPLE CHOICE 1. The diffusion of carbon dioxide across the alveolar capillary membrane is. A.

More information

Identification and Treatment of the Patient with Sleep Related Hypoventilation

Identification and Treatment of the Patient with Sleep Related Hypoventilation Identification and Treatment of the Patient with Sleep Related Hypoventilation Hillary Loomis-King, MD Pulmonary and Critical Care of NW MI Munson Sleep Disorders Center X Conflict of Interest Disclosures

More information

, OR 8.73 (95% CI

, OR 8.73 (95% CI 550 Thorax 2000;55:550 554 Department of Respiratory Medicine, St James s University Hospital, Leeds LS9 7TF, UK P K Plant JLOwen M W Elliott Correspondence to: Dr P K Plant email: mbriggs@alwoodley.u-net.com

More information

Arterial Blood Gases. Dr Mark Young Mater Health Services

Arterial Blood Gases. Dr Mark Young Mater Health Services Arterial Blood Gases Dr Mark Young Mater Health Services Why do them? Quick results Bedside test Range of important information Oxygenation Effectiveness of gas exchange Control of ventilation Acid base

More information

Interpretation of Arterial Blood Gases. Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB)

Interpretation of Arterial Blood Gases. Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB) Interpretation of Arterial Blood Gases Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB) Before interpretation of ABG Make/Take note of Correct puncture

More information

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease 136 PHYSIOLOGY CASES AND PROBLEMS Case 24 Chronic Obstructive Pulmonary Disease Bernice Betweiler is a 73-year-old retired seamstress who has never been married. She worked in the alterations department

More information

Average volume-assured pressure support

Average volume-assured pressure support Focused review Average volume-assured pressure support Abdurahim Aloud MD Abstract Average volume-assured pressure support (AVAPS) is a relatively new mode of noninvasive positive pressure ventilation

More information

Chronic Obstructive Pulmonary Disease (COPD) Clinical Guideline

Chronic Obstructive Pulmonary Disease (COPD) Clinical Guideline Chronic Obstructive Pulmonary Disease (COPD) Clinical These clinical guidelines are designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients. They

More information

RESPIRATION AND SLEEP AT HIGH ALTITUDE

RESPIRATION AND SLEEP AT HIGH ALTITUDE MANO Pulmonologist-Intensivis Director of ICU and Sleep Dis Evangelism Ath RESPIRATION AND SLEEP AT HIGH ALTITUDE 2 nd Advanced Course in Mountain Medicine MAY 25-27 OLYMPUS MOUNTAIN Respiration Breathing

More information

Respiratory Pathophysiology Cases Linda Costanzo Ph.D.

Respiratory Pathophysiology Cases Linda Costanzo Ph.D. Respiratory Pathophysiology Cases Linda Costanzo Ph.D. I. Case of Pulmonary Fibrosis Susan was diagnosed 3 years ago with diffuse interstitial pulmonary fibrosis. She tries to continue normal activities,

More information

COPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis.

COPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis. 1 Definition of COPD: COPD is a syndrome of chronic limitation in expiratory airflow encompassing emphysema or chronic bronchitis. Airflow obstruction may be accompanied by airway hyper-responsiveness

More information

COPD Challenge CASE PRESENTATION

COPD Challenge CASE PRESENTATION Chronic obstructive pulmonary disease (COPD) exacerbations may make up more than 10% of acute medical admissions [1], and they are increasingly recognised as a cause of significant morbidity and mortality

More information

BTS Guideline for Home Oxygen use in adults Appendix 9 (online only) Key Questions - PICO 10 December 2012

BTS Guideline for Home Oxygen use in adults Appendix 9 (online only) Key Questions - PICO 10 December 2012 BTS Guideline for Home Oxygen use in adults Appendix 9 (online only) Key Questions - PICO 10 December 2012 Evidence base for Home Oxygen therapy in COPD, non-copd respiratory disease and nonrespiratory

More information

There are number of parameters which are measured: ph Oxygen (O 2 ) Carbon Dioxide (CO 2 ) Bicarbonate (HCO 3 -) AaDO 2 O 2 Content O 2 Saturation

There are number of parameters which are measured: ph Oxygen (O 2 ) Carbon Dioxide (CO 2 ) Bicarbonate (HCO 3 -) AaDO 2 O 2 Content O 2 Saturation Arterial Blood Gases (ABG) A blood gas is exactly that...it measures the dissolved gases in your bloodstream. This provides one of the best measurements of what is known as the acid-base balance. The body

More information

Oxygen and ABG. Dr Will Dooley

Oxygen and ABG. Dr Will Dooley Oxygen and ABG G Dr Will Dooley Oxygen and ABGs Simply in 10 cases Recap of: ABG interpretation Oxygen management Some common concerns A-a gradient Base Excess Anion Gap COPD patients CPAP/BiPAP First

More information

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water Module H: Carbon Dioxide Transport Beachey Ch 9 & 10 Egan pp. 244-246, 281-284 Carbon Dioxide Transport At the end of today s session you will be able to : Describe the relationship free hydrogen ions

More information

Chronic Obstructive Pulmonary Disease (COPD).

Chronic Obstructive Pulmonary Disease (COPD). Chronic Obstructive Pulmonary Disease (COPD). Linde: Living healthcare 02 03 Chronic Obstructive Pulmonary Disease (COPD). A pocket guide for healthcare professionals. COPD the facts Moderate to severe

More information

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL)

5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL) Self-Assessment RSPT 2350: Module F - ABG Analysis 1. You are called to the ER to do an ABG on a 40 year old female who is C/O dyspnea but seems confused and disoriented. The ABG on an FiO 2 of.21 show:

More information

Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist. This program has been approved for 1 hour of continuing education credit.

Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist. This program has been approved for 1 hour of continuing education credit. Ron Hosp, MS-HSA, RRT Regional Respiratory Specialist This program has been approved for 1 hour of continuing education credit. Course Objectives Identify at least four goals of home NIV Identify candidates

More information

Over the last several years various national and

Over the last several years various national and Recommendations for the Management of COPD* Gary T. Ferguson, MD, FCCP Three sets of guidelines for the management of COPD that are widely recognized (from the European Respiratory Society [ERS], American

More information

Emergency oxygen therapy for the COPD patient

Emergency oxygen therapy for the COPD patient Emerg Med J 2001;18:333 339 333 Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK R Murphy Department of Emergency Medicine, Hope Hospital, Salford, UK

More information

Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients

Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific

More information

Interpretation of Arterial Blood Gases (ABG)

Interpretation of Arterial Blood Gases (ABG) Interpretation of Arterial Blood Gases (ABG) Prof. Dr. W. Vincken Head Respiratory Division Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) 29-3-2015 W Vincken - UZ Brussel

More information

OXYGENATION AND ACID- BASE EVALUATION. Chapter 1

OXYGENATION AND ACID- BASE EVALUATION. Chapter 1 OXYGENATION AND ACID- BASE EVALUATION Chapter 1 MECHANICAL VENTILATION Used when patients are unable to sustain the level of ventilation necessary to maintain the gas exchange functions Artificial support

More information

COMPARISON BETWEEN INTERCOSTAL STRETCH AND BREATHING CONTROL ON PULMONARY FUNCTION PARAMETER IN SMOKING ADULTHOOD: A PILOT STUDY

COMPARISON BETWEEN INTERCOSTAL STRETCH AND BREATHING CONTROL ON PULMONARY FUNCTION PARAMETER IN SMOKING ADULTHOOD: A PILOT STUDY COMPARISON BETWEEN INTERCOSTAL STRETCH AND BREATHING CONTROL ON PULMONARY FUNCTION PARAMETER IN SMOKING ADULTHOOD: A PILOT STUDY Shereen Inkaew 1 Kamonchat Nalam 1 Panyaporn Panya 1 Pramook Pongsuwan 1

More information

RESPIRATORY FAILURE. Dr Graeme McCauley KGH

RESPIRATORY FAILURE. Dr Graeme McCauley KGH RESPIRATORY FAILURE Dr Graeme McCauley KGH Definitions Failure to oxygenate-pao2 < 60 Failure to clear CO2-PaCO2 > 50 Acute vs Chronic Hypoxemic failure- type l Hypercapneic failure- type ll Causes of

More information

Oxygen therapy increases the arterial partial pressure of

Oxygen therapy increases the arterial partial pressure of High flow or titrated oxygen for obese medical inpatients: a randomised crossover trial Janine Pilcher 1, Michael Richards 1, Leonie Eastlake 1, Steven J McKinstry 1, George Bardsley 1, Sarah Jefferies

More information

Arterial Blood Gases Interpretation Definition Values respiratory metabolic

Arterial Blood Gases Interpretation Definition Values respiratory metabolic Arterial Blood Gases Interpretation Definition A blood gas test measures the amount of oxygen and carbon dioxide in the blood. It is also useful in determining the ph level of the blood. The test is commonly

More information

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4

INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 INDICATIONS FOR RESPIRATORY ASSISTANCE A C U T E M E D I C I N E U N I T P - Y E A R M B B S 4 RESPIRATORY FAILURE Acute respiratory failure is defined by hypoxemia with or without hypercapnia. It is one

More information

Oxygen Therapy: When, What and Why

Oxygen Therapy: When, What and Why Oxygen Therapy: When, What and Why SOUTH EAST LONDON OXYGEN STUDY DAY 26/5/2016 Dr Irem Patel, Integrated Respiratory Physician, King s Health Partners Oxygen: A medicine to treat hypoxia What I will cover

More information

ARTERIAL BLOOD GAS ANALYSIS IN ACUTE AND CHRONIC BRONCHIAL ASTHMA

ARTERIAL BLOOD GAS ANALYSIS IN ACUTE AND CHRONIC BRONCHIAL ASTHMA Research Article E-ISSN 2341-4103 ARTERIAL BLOOD GAS ANALYSIS IN ACUTE AND CHRONIC BRONCHIAL PADMAVATHI. K, SUMANGALI.P, SUBASH.Y.E @ Assistant professor, Department of Physiology, Siddhartha Medical College,

More information

Assessing perioperative risk

Assessing perioperative risk Assessing perioperative risk Chronic Obstructive Pulmonary Disease Dr. Michelle Caldecott Respiratory & Sleep Physician Epworth Healthcare Austin Health Impact of COPD on Postoperative Outcomes: Results

More information

The use of proning in the management of Acute Respiratory Distress Syndrome

The use of proning in the management of Acute Respiratory Distress Syndrome Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning

More information

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley

SIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley SIMPLY Arterial Blood Gases Interpretation Week 4 Dr William Dooley Plan Structure for interpretation 5-step approach Works for majority of cases Case scenarios Some common concerns A-a gradient BE Anion

More information

Introduction and Overview of Acute Respiratory Failure

Introduction and Overview of Acute Respiratory Failure Introduction and Overview of Acute Respiratory Failure Definition: Acute Respiratory Failure Failure to oxygenate Inadequate PaO 2 to saturate hemoglobin PaO 2 of 60 mm Hg ~ SaO 2 of 90% PaO 2 of 50 mm

More information

Arterial Blood Gas Analysis

Arterial Blood Gas Analysis Arterial Blood Gas Analysis L Lester www.3bv.org Bones, Brains & Blood Vessels Drawn from radial or femoral arteries. Invasive procedure Caution must be taken with patient on anticoagulants ph: 7.35-7.45

More information

Respiratory Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross

Respiratory Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross Respiratory Physiology Part II Bio 219 Napa Valley College Dr. Adam Ross Gas exchange Gas exchange in the lungs (to capillaries) occurs by diffusion across respiratory membrane due to differences in partial

More information

2/4/2019. GOLD Objectives. GOLD 2019 Report: Chapters

2/4/2019. GOLD Objectives. GOLD 2019 Report: Chapters GOLD Objectives To provide a non biased review of the current evidence for the assessment, diagnosis and treatment of patients with COPD. To highlight short term and long term treatment objectives organized

More information

For more information about how to cite these materials visit

For more information about how to cite these materials visit Author(s): John G. Younger, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

More information

Renal Fractional Excretion of Sodium in Relation to Arterial Blood Gas and Spirometric Parameters in Chronic Obstructive Pulmonary Disease

Renal Fractional Excretion of Sodium in Relation to Arterial Blood Gas and Spirometric Parameters in Chronic Obstructive Pulmonary Disease Renal Fractional Excretion of Sodium in Relation to Arterial Blood Gas and Spirometric Parameters in Chronic Obstructive Pulmonary Disease Fariba Rezaeetalab 1, Abbas Ali Zeraati 2, Sayyed Hosien Mostafania

More information

Respiratory Failure. Causes of Acute Respiratory Failure (ARF): a- Intrapulmonary:

Respiratory Failure. Causes of Acute Respiratory Failure (ARF): a- Intrapulmonary: Respiratory failure exists whenever the exchange of O 2 for CO 2 in the lungs cannot keep up with the rate of O 2 consumption & CO 2 production in the cells of the body. This results in a fall in arterial

More information

Influence of inspired oxygen concentration on PaCO 2 during noninvasive ventilation in patients with chronic obstructive pulmonary disease

Influence of inspired oxygen concentration on PaCO 2 during noninvasive ventilation in patients with chronic obstructive pulmonary disease Influence of inspired oxygen concentration on PaCO 2 during noninvasive ventilation in patients with chronic obstructive pulmonary disease Running title: oxygen therapy for COPD patients during NIV Authors:

More information

Lecture Notes. Chapter 4: Chronic Obstructive Pulmonary Disease (COPD)

Lecture Notes. Chapter 4: Chronic Obstructive Pulmonary Disease (COPD) Lecture Notes Chapter 4: Chronic Obstructive Pulmonary Disease (COPD) Objectives Define COPD Estimate incidence of COPD in the US Define factors associated with onset of COPD Describe the clinical features

More information

Respiratory Medicine. Some pet peeves and other random topics. Kyle Perrin

Respiratory Medicine. Some pet peeves and other random topics. Kyle Perrin Respiratory Medicine Some pet peeves and other random topics Kyle Perrin Overview 1. Acute asthma Severity assessment and management 2. Acute COPD NIV and other management 3. Respiratory problems in the

More information

Oxygen prescription and administration at the Emergency Department and medical wards in Mater Dei Hospital

Oxygen prescription and administration at the Emergency Department and medical wards in Mater Dei Hospital Original Article Oxygen prescription and administration at the Emergency Department and medical wards in Mater Dei Hospital Rachelle Asciak, Valerie Anne Fenech, Jurgen Gatt, Stephen Montefort Abstract

More information

Gustavo J. Rodrigo, MD; Mario Rodriquez Verde, MD; Virginia Peregalli, MD; and Carlos Rodrigo, MD

Gustavo J. Rodrigo, MD; Mario Rodriquez Verde, MD; Virginia Peregalli, MD; and Carlos Rodrigo, MD Effects of Short-term 28% and 100% Oxygen on PaCO 2 and Peak Expiratory Flow Rate in Acute Asthma* A Randomized Trial Gustavo J. Rodrigo, MD; Mario Rodriquez Verde, MD; Virginia Peregalli, MD; and Carlos

More information

Acute NIV in COPD and what happens next. Dr Rachael Evans PhD Associate Professor, Respiratory Medicine, Glenfield Hospital

Acute NIV in COPD and what happens next. Dr Rachael Evans PhD Associate Professor, Respiratory Medicine, Glenfield Hospital Acute NIV in COPD and what happens next Dr Rachael Evans PhD Associate Professor, Respiratory Medicine, Glenfield Hospital Content Scenarios Evidence based medicine for the first 24 hrs Who should we refer

More information

UNIT VI: ACID BASE IMBALANCE

UNIT VI: ACID BASE IMBALANCE UNIT VI: ACID BASE IMBALANCE 1 Objectives: Review the physiological mechanism responsible to regulate acid base balance in the body i.e.: Buffers (phosphate, hemoglobin, carbonate) Renal mechanism Respiratory

More information

BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT

BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides

More information

(To be filled by the treating physician)

(To be filled by the treating physician) CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type

More information

Pulmonary Pathophysiology

Pulmonary Pathophysiology Pulmonary Pathophysiology 1 Reduction of Pulmonary Function 1. Inadequate blood flow to the lungs hypoperfusion 2. Inadequate air flow to the alveoli - hypoventilation 2 Signs and Symptoms of Pulmonary

More information

Exacerbations of COPD. Dr J Cullen

Exacerbations of COPD. Dr J Cullen Exacerbations of COPD Dr J Cullen Definition An AECOPD is a sustained worsening of the patient s clinical condition from their stable state that is beyond their usual day-to-day variation is acute in onset

More information

Lab 4: Respiratory Physiology and Pathophysiology

Lab 4: Respiratory Physiology and Pathophysiology Lab 4: Respiratory Physiology and Pathophysiology This exercise is completed as an in class activity and including the time for the PhysioEx 9.0 demonstration this activity requires ~ 1 hour to complete

More information

Policy Specific Section: October 1, 2010 January 21, 2013

Policy Specific Section: October 1, 2010 January 21, 2013 Medical Policy Bi-level Positive Airway Pressure (BPAP/NPPV) Type: Medical Necessity/Not Medical Necessity Policy Specific Section: Durable Medical Equipment Original Policy Date: Effective Date: October

More information

Objectives. Health care significance of ARF 9/10/15 TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION

Objectives. Health care significance of ARF 9/10/15 TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION TREATMENT OF ACUTE RESPIRATORY FAILURE OF VARIABLE CAUSES: INVASIVE VS. NON- INVASIVE VENTILATION Louisa Chika Ikpeama, DNP, CCRN, ACNP-BC Objectives Identify health care significance of acute respiratory

More information

3/30/12. Luke J. Gasowski BS, BSRT, NREMT-P, FP-C, CCP-C, RRT-NPS

3/30/12. Luke J. Gasowski BS, BSRT, NREMT-P, FP-C, CCP-C, RRT-NPS Luke J. Gasowski BS, BSRT, NREMT-P, FP-C, CCP-C, RRT-NPS 1) Define and describe ETCO 2 2) Explain methods of measuring ETCO 2 3) Describe various clinical applications of ETCO 2 4) Describe the relationship

More information

Causes and Consequences of Respiratory Centre Depression and Hypoventilation

Causes and Consequences of Respiratory Centre Depression and Hypoventilation Causes and Consequences of Respiratory Centre Depression and Hypoventilation Lou Irving Director Respiratory and Sleep Medicine, RMH louis.irving@mh.org.au Capacity of the Respiratory System At rest During

More information

Control of Respiration

Control of Respiration Control of Respiration Graphics are used with permission of: adam.com (http://www.adam.com/) Benjamin Cummings Publishing Co (http://www.awl.com/bc) Page 1. Introduction The basic rhythm of breathing is

More information

Lecture Notes. Chapter 2: Introduction to Respiratory Failure

Lecture Notes. Chapter 2: Introduction to Respiratory Failure Lecture Notes Chapter 2: Introduction to Respiratory Failure Objectives Define respiratory failure, ventilatory failure, and oxygenation failure List the causes of respiratory failure Describe the effects

More information

Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia

Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia Original Article Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia Eun Sun Kim, Hongyeul Lee, Se Joong Kim, Jisoo Park, Yeon Joo Lee, Jong Sun Park,

More information

Capnography. Capnography. Oxygenation. Pulmonary Physiology 4/15/2018. non invasive monitor for ventilation. Edward C. Adlesic, DMD.

Capnography. Capnography. Oxygenation. Pulmonary Physiology 4/15/2018. non invasive monitor for ventilation. Edward C. Adlesic, DMD. Capnography Edward C. Adlesic, DMD University of Pittsburgh School of Dental Medicine 2018 North Carolina Program Capnography non invasive monitor for ventilation measures end tidal CO2 early detection

More information

Indications for Respiratory Assistance. Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer

Indications for Respiratory Assistance. Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer Indications for Respiratory Assistance Sheba Medical Center, ICU Department Nick D Ardenne St George s University of London Tel Hashomer Respiratory Assistance Non-invasive - Nasal specs - Facemask/ Resevoir

More information

ARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017

ARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017 ARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017 WHAT INFORMATION DOES AN ABG GIVE US? ph = measure of hydrogen ion concentration (acidity or alkalinity) PaCO2 = partial pressure

More information

Title: The Feasibility of Domiciliary Non-Invasive Mechanical Ventilation due to Chronic Respiratory Failure in Very Elderly Patients

Title: The Feasibility of Domiciliary Non-Invasive Mechanical Ventilation due to Chronic Respiratory Failure in Very Elderly Patients Manuscript type: Original Article DOI: 10.5152/TurkThoracJ.2018.18119 Title: The Feasibility of Domiciliary Non-Invasive Mechanical Ventilation due to Chronic Respiratory Failure in Very Elderly Patients

More information

Respiratory Failure how the respiratory physicians deal with airway emergencies

Respiratory Failure how the respiratory physicians deal with airway emergencies Respiratory Failure how the respiratory physicians deal with airway emergencies Dr Michael Davies MD FRCP Consultant Respiratory Physician Respiratory Support and Sleep Centre Papworth Hospital NHS Foundation

More information

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation.

1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. Chapter 1: Principles of Mechanical Ventilation TRUE/FALSE 1. When a patient fails to ventilate or oxygenate adequately, the problem is caused by pathophysiological factors such as hyperventilation. F

More information

Oxygenation. Chapter 45. Re'eda Almashagba 1

Oxygenation. Chapter 45. Re'eda Almashagba 1 Oxygenation Chapter 45 Re'eda Almashagba 1 Respiratory Physiology Structure and function Breathing: inspiration, expiration Lung volumes and capacities Pulmonary circulation Respiratory gas exchange: oxygen,

More information

Basic mechanisms disturbing lung function and gas exchange

Basic mechanisms disturbing lung function and gas exchange Basic mechanisms disturbing lung function and gas exchange Blagoi Marinov, MD, PhD Pathophysiology Department, Medical University of Plovdiv Respiratory system 1 Control of breathing Structure of the lungs

More information

AECOPD: Management and Prevention

AECOPD: Management and Prevention Neil MacIntyre MD Duke University Medical Center Durham NC Professor P.J. Barnes, MD, National Heart and Lung Institute, London UK Professor Peter J. Barnes, MD National Heart and Lung Institute, London

More information

Clinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene

Clinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene Clinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene Emily S. Wan, John E. Hokanson, James R. Murphy, Elizabeth A. Regan, Barry J. Make, David A. Lynch, James D. Crapo, Edwin K.

More information

Acute noninvasive ventilation what s the evidence? Respiratory Medicine Update: Royal College of Physicians & BTS Thu 28 th January 2016

Acute noninvasive ventilation what s the evidence? Respiratory Medicine Update: Royal College of Physicians & BTS Thu 28 th January 2016 Acute noninvasive ventilation what s the evidence? Respiratory Medicine Update: Royal College of Physicians & BTS Thu 28 th January 2016 Annabel Nickol Consultant in Respiratory Medicine, Sleep & Ventilation

More information

Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma

Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma See Editorial, p 931 < Additional tables are published online only. To view these files please visit the journal online (http://thorax.bmj. com). 1 Medical Research Institute of New Zealand, Wellington,

More information

Time course and recovery of arterial blood gases during exacerbations in adults with Cystic Fibrosis

Time course and recovery of arterial blood gases during exacerbations in adults with Cystic Fibrosis Journal of Cystic Fibrosis 8 (2009) 9 13 www.elsevier.com/locate/jcf Time course and recovery of arterial blood gases during exacerbations in adults with Cystic Fibrosis D.F. Waterhouse, A.M. McLaughlin,

More information

THE EFFECTS OF MEDROXYPROGESTERONE ACETATE AND ACETAZOLAMIDE ON THE NOCTURNAL OXYGEN SATURATION IN COPD PATIENTS

THE EFFECTS OF MEDROXYPROGESTERONE ACETATE AND ACETAZOLAMIDE ON THE NOCTURNAL OXYGEN SATURATION IN COPD PATIENTS THE EFFECTS OF MEDROXYPROGESTERONE ACETATE AND ACETAZOLAMIDE ON THE NOCTURNAL OXYGEN SATURATION IN COPD PATIENTS Wagenaar, M., Vos, P., Heijdra, Y., Herwaarden, C. van, Folgering, H. Departement of Pulmonary

More information

Transcutaneous Monitoring and Case Studies

Transcutaneous Monitoring and Case Studies Transcutaneous Monitoring and Case Studies Objectives General concept, applications and principles of operation Role of TCM in clinical settings Role of TCM in home care settings Need for continuous TCM

More information

Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome

Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome 708 Department of Respiratory Medicine, St James s University Hospital, Leeds LS9 7TF, UK P K Plant JLOwen M W Elliott Correspondence to: Dr P K Plant Paul.Plant@ gw.sjsuh.northy.nhs.uk Received 25 July

More information

Oxygen Use in Palliative Care Guideline and Flowchart

Oxygen Use in Palliative Care Guideline and Flowchart Oxygen Use in Palliative Care Guideline and Flowchart Reviewed: October 2013 Gippsland Region Palliative Care Consortium Clinical Practice Group Policy. Title Keywords Ratified Oxygen Use in Palliative

More information

NON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018

NON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018 NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring

More information

Audit of acute admissions of COPD: standards of care and management in the hospital setting

Audit of acute admissions of COPD: standards of care and management in the hospital setting Eur Respir J 2001; 17: 343 349 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2001 European Respiratory Journal ISSN 0903-1936 Audit of acute admissions of COPD: standards of care and management

More information

High Flow Nasal Cannula in Children During Sleep. Brian McGinley M.D. Associate Professor of Pediatrics University of Utah

High Flow Nasal Cannula in Children During Sleep. Brian McGinley M.D. Associate Professor of Pediatrics University of Utah High Flow Nasal Cannula in Children During Sleep Brian McGinley M.D. Associate Professor of Pediatrics University of Utah Disclosures Conflicts of Interest: None Will discuss a product that is commercially

More information

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure.

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. B. 10 Applied Respiratory Physiology a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. Intermittent positive pressure ventilation

More information

Pulmonary Pearls. Medical Pearls. Case 1: Case 1 (cont.): Case 1: What is the Most Likely Diagnosis? Case 1 (cont.):

Pulmonary Pearls. Medical Pearls. Case 1: Case 1 (cont.): Case 1: What is the Most Likely Diagnosis? Case 1 (cont.): Pulmonary Pearls Christopher H. Fanta, MD Pulmonary and Critical Care Division Brigham and Women s Hospital Partners Asthma Center Harvard Medical School Medical Pearls Definition: Medical fact that is

More information

POLICIES AND PROCEDURE MANUAL

POLICIES AND PROCEDURE MANUAL POLICIES AND PROCEDURE MANUAL Policy: MP230 Section: Medical Benefit Policy Subject: Outpatient Pulmonary Rehabilitation I. Policy: Outpatient Pulmonary Rehabilitation II. Purpose/Objective: To provide

More information

Home Mechanical Ventilation

Home Mechanical Ventilation The International Convention Centre (ICC), Birmingham 11 12 September 2017 Home Mechanical Ventilation Martin Latham Nurse Specialist in Sleep Disordered Breathing St James s University Hospital Leeds

More information

Acute respiratory failure. Arterial blood gas assessment. finn rasmussen 2011

Acute respiratory failure. Arterial blood gas assessment. finn rasmussen 2011 Acute respiratory failure Arterial blood gas assessment finn rasmussen 2011 Normal P a CO 2 = 40mmHg Normal P a O 2 = 90-95 mmhg ALVEOLAR VENTILATION Normal HCO 3- = 22-27 mmol/l H + 2 0 CO + 2 H HCO -

More information

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see: bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest

More information

Authors: Corresponding author: Yasuhiro Kamii Tel: Fax:

Authors: Corresponding author: Yasuhiro Kamii   Tel: Fax: Investigation of chronic obstructive pulmonary disease patients discharged without home mechanical ventilation after in-hospital use of acute non-invasive ventilation Authors: Yasuhiro Kamii, MD Hirotoshi

More information

SWISS SOCIETY OF NEONATOLOGY. Supercarbia in an infant with meconium aspiration syndrome

SWISS SOCIETY OF NEONATOLOGY. Supercarbia in an infant with meconium aspiration syndrome SWISS SOCIETY OF NEONATOLOGY Supercarbia in an infant with meconium aspiration syndrome January 2006 2 Wilhelm C, Frey B, Department of Intensive Care and Neonatology, University Children s Hospital Zurich,

More information

Bilevel positive airway pressure nasal mask ventilation in patients with acute hypercapnic respiratory failure

Bilevel positive airway pressure nasal mask ventilation in patients with acute hypercapnic respiratory failure Bilevel positive airway pressure nasal mask ventilation in patients with acute hypercapnic respiratory failure CK Chan, KS Lau, HC Fan, CW Lam The efficacy and complications of bilevel positive airway

More information

3. Which statement is false about anatomical dead space?

3. Which statement is false about anatomical dead space? Respiratory MCQs 1. Which of these statements is correct? a. Regular bronchioles are the most distal part of the respiratory tract to contain glands. b. Larynx do contain significant amounts of smooth

More information

EFFICACY OF BIPAP IN PATIENTS ADMITTED WITH HYPERCAPNIC RESPIRATORY FAILURE; AN EXPERIENCE AT A TERTIARY CARE HOSPITAL

EFFICACY OF BIPAP IN PATIENTS ADMITTED WITH HYPERCAPNIC RESPIRATORY FAILURE; AN EXPERIENCE AT A TERTIARY CARE HOSPITAL ORIGINAL ARTICLE EFFICACY OF BIPAP IN PATIENTS ADMITTED WITH HYPERCAPNIC RESPIRATORY FAILURE; AN EXPERIENCE AT A TERTIARY CARE HOSPITAL Hussain Ahmad*, Saadia Ashraf*, Rukhsana Javed Farooqi*, Mukhtiar

More information

a. Will not suppress respiratory drive in acute asthma

a. Will not suppress respiratory drive in acute asthma Status Asthmaticus & COPD with Respiratory Failure - Key Points M.J. Betzner MD FRCPc - NYEMU Toronto 2018 Overview This talk is about the sickest of the sick patients presenting with severe or near death

More information

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see: bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest

More information

PATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1).

PATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1). PATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1). 1 Inform Consent Date: / / dd / Mmm / yyyy 2 Patient identifier: Please enter the 6 digit Patient identification number from your site patient log

More information

Study No.: Title: Rationale: Phase: Study Period Study Design: Centres: Indication: Treatment: Objectives : Primary Outcome/Efficacy Variable:

Study No.: Title: Rationale: Phase: Study Period Study Design: Centres: Indication: Treatment: Objectives : Primary Outcome/Efficacy Variable: The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.

More information

HQO s Episode of Care for Chronic Obstructive Pulmonary Disease

HQO s Episode of Care for Chronic Obstructive Pulmonary Disease HQO s Episode of Care for Chronic Obstructive Pulmonary Disease Dr. Chaim Bell, MD PhD FRCPC Ontario Hospital Association Webcast October 23, 2013 Objectives 1. Describe the rationale and methodology for

More information

OXYGEN USE IN PHYSICAL THERAPY PRACTICE. Rebecca H. Crouch, PT,DPT,MS,CCS,FAACVPR

OXYGEN USE IN PHYSICAL THERAPY PRACTICE. Rebecca H. Crouch, PT,DPT,MS,CCS,FAACVPR OXYGEN USE IN PHYSICAL THERAPY PRACTICE Rebecca H. Crouch, PT,DPT,MS,CCS,FAACVPR Supplemental Oxygen Advantages British Medical Research Council Clinical Trial Improved survival using oxygen 15 hrs/day

More information

Hypoxic and hypercapnic response in asthmatic

Hypoxic and hypercapnic response in asthmatic Hypoxic and hypercapnic response in asthmatic subjects with previous respiratory failure ARLENE A HUTCHISON, ANTHONY OLINSKY From the Department of Thoracic Medicine, Royal Children's Hospital, Melbourne,

More information

New Government O2 Criteria and Expert Panel. Jennifer Despain, RPSGT, RST, AS

New Government O2 Criteria and Expert Panel. Jennifer Despain, RPSGT, RST, AS New Government O2 Criteria and Expert Panel Jennifer Despain, RPSGT, RST, AS Lead Sleep Technologist, Central Utah Clinic Sleep Disorders Center; Provo, Utah Objectives: Review new government O2 criteria

More information