Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease

Background: The Norfolk and Norwich University Hospital (NNUH) is situa ted in rural Norfolk, and ambulance journey times are often >30 min. Longer ambulance journeys could lead to a greater risk of hypercapnia, if inappropriately high concentrations of oxygen are given during an exacerbation of COPD. Aim: To investigate the effect of high concentration oxygen (HCO, FiO2 > 0.28) on COPD patients, and the outcome of instituting a simple protocol to reduce such exposure. Design: Retrospe ctive audit. Method: An audit was conducted of all patients admitted with an exacerbation of COPD to the NNUH during the 2 months from 1 December 2001 to 31 January 2002 (n=108). Results were shared with paramedics, and guidelines agreed for the initial provision of lower concentrations of oxygen (LCO, FiO2 ≤ 0.28). A second audit was conducted a year later between 1 December 2002 and 31 January 2003 (n=103). Results: HCO caused significant (