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Randomized Controlled Trial
. 2018 Oct 3;18(1):157.
doi: 10.1186/s12890-018-0720-7.

Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial

George Bardsley  1   2 , Janine Pilcher  1   2   3 , Steven McKinstry  1   2   3 , Philippa Shirtcliffe  1   2 , James Berry  2   4 , James Fingleton  1   2 , Mark Weatherall  4 , Richard Beasley  5   6   7
Affiliations
Randomized Controlled Trial

Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial

George Bardsley et al. BMC Pulm Med. .

Abstract

Background: In exacerbations of chronic obstructive pulmonary disease, administration of high concentrations of oxygen may cause hypercapnia and increase mortality compared with oxygen titrated, if required, to achieve an oxygen saturation of 88-92%. Optimally titrated oxygen regimens require two components: titrated supplemental oxygen to achieve the target oxygen saturation and, if required, bronchodilators delivered by air-driven nebulisation. The effect of repeated air vs oxygen-driven bronchodilator nebulisation in acute exacerbations of chronic obstructive pulmonary disease is unknown. We aimed to compare the effects of air versus oxygen-driven bronchodilator nebulisation on arterial carbon dioxide tension in exacerbations of chronic obstructive pulmonary disease.

Methods: A parallel group double-blind randomised controlled trial in 90 hospital in-patients with an acute exacerbation of COPD. Participants were randomised to receive two 2.5 mg salbutamol nebulisers, both driven by air or oxygen at 8 L/min, each delivered over 15 min with a 5 min interval in-between. The primary outcome measure was the transcutaneous partial pressure of carbon dioxide at the end of the second nebulisation (35 min). The primary analysis used a mixed linear model with fixed effects of the baseline PtCO2, time, the randomised intervention, and a time by intervention interaction term; to estimate the difference between randomised treatments at 35 min. Analysis was by intention-to-treat.

Results: Oxygen-driven nebulisation was terminated in one participant after 27 min when the PtCO2 rose by > 10 mmHg, a predefined safety criterion. The mean (standard deviation) change in PtCO2 at 35 min was 3.4 (1.9) mmHg and 0.1 (1.4) mmHg in the oxygen and air groups respectively, difference (95% confidence interval) 3.3 mmHg (2.7 to 3.9), p < 0.001. The proportion of patients with a PtCO2 change ≥4 mmHg during the intervention was 18/45 (40%) and 0/44 (0%) for oxygen and air groups respectively.

Conclusions: Oxygen-driven nebulisation leads to an increase in PtCO2 in exacerbations of COPD. We propose that air-driven bronchodilator nebulisation is preferable to oxygen-driven nebulisation in exacerbations of COPD.

Trial registration: Australian New Zealand Clinical Trials Registry number ACTRN12615000389505 . Registration confirmed on 28/4/15.

Keywords: Air; Bronchodilator agents; Hypercapnia; Nebulisation; Oxygen.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was obtained from the Health and Disability Ethics Committee, New Zealand (Reference 14/NTB/200). Written informed consent was obtained before any study-specific procedures.

Consent for publication

Not applicable.

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. All authors have no competing interests to declare, other than the MRINZ receiving research funding from Health Research Council of New Zealand.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participant flow through the study and allocation of interventions
Fig. 2
Fig. 2
PtCO2 change from baseline (T = 0) to T = 35 min. Mean PtCO2 with error bars showing one SD, by time and intervention
Fig. 3
Fig. 3
Time-course of SpO2 throughout study period (Blue = Oxygen-driven nebuliser group, Red = Air-driven nebuliser group)
See this image and copyright information in PMC

References

    1. M a A, Wills KE, Blizzard L, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462. doi: 10.1136/bmj.c5462. - DOI - PMC - PubMed
    1. Murphy R, Driscoll P, O’Driscoll R. Emergency oxygen therapy for the COPD patient. Emerg Med J. 2001;18:333–339. doi: 10.1136/emj.18.5.333. - DOI - PMC - PubMed
    1. Edwards L, Perrin K, Williams M, et al. Randomised controlled crossover trial of the effect on PtCO2 of oxygen-driven versus air-driven nebulisers in severe chronic obstructive pulmonary disease. Emerg Med J. 2012;29:894–898. doi: 10.1136/emermed-2011-200443. - DOI - PubMed
    1. Gunawardena KA, Patel B, Campbell IA, et al. Oxygen as a driving gas for nebulisers: safe or dangerous? Br Med J (Clin Res Ed) 1984;288:272–274. doi: 10.1136/bmj.288.6413.272. - DOI - PMC - PubMed
    1. O'Donnell D, Kelly CP, Cotter P, Clancy L. Use of oxygen driven nebuliser delivery systems for beta-2 agonists in chronic bronchitis. Ir J Med Sci. 1985;154:198–200. doi: 10.1007/BF02937361. - DOI - PubMed

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