From the Guidelines
A non-rebreather (NRB) mask is not recommended as the initial oxygen delivery device for patients with Chronic Obstructive Pulmonary Disease (COPD) exacerbation due to the risk of inducing hypercapnic respiratory failure. The British Thoracic Society guideline for oxygen use in adults in healthcare and emergency settings, published in Thorax in 2017 1, emphasizes the importance of avoiding excessive oxygen use in patients with COPD to prevent respiratory acidosis.
Key Considerations for Oxygen Therapy in COPD
- The goal is to maintain an oxygen saturation of 94–98% unless there is a history of previous hypercapnic respiratory failure requiring non-invasive ventilation (NIV) or intermittent positive pressure ventilation, or if the patient’s usual oxygen saturation when clinically stable is below 94% 1.
- For patients with a history of hypercapnic respiratory failure or those whose usual oxygen saturation is below 94%, the target oxygen saturation range should be 88–92% 1.
- Blood gases should be monitored closely, with repeat measurements at 30–60 minutes after initiation of oxygen therapy, or sooner if there is evidence of clinical deterioration, to detect any signs of rising PCO2 or falling pH 1.
Appropriate Use of Non-Rebreather Masks
Non-rebreather masks deliver high-flow oxygen (up to 90% FiO2) and are typically reserved for severely hypoxemic COPD patients who are not responding to lower oxygen concentrations. However, their use should be limited to short periods while preparing for more appropriate interventions like NIV or intubation, due to the risk of inducing hypercapnic respiratory failure 1.
Monitoring and Adjunctive Treatments
When a non-rebreather mask is used in COPD, close monitoring of respiratory rate, work of breathing, and arterial blood gases is crucial to detect CO2 retention early. Other treatments for COPD exacerbations, including bronchodilators, systemic corticosteroids, and antibiotics if indicated, should be administered concurrently to address the underlying cause of the exacerbation.
From the Research
Role of Non-Rebreather (NRB) Mask in COPD Exacerbation
- The provided studies do not directly discuss the role of a non-rebreather (NRB) mask in Chronic Obstructive Pulmonary Disease (COPD) exacerbation 2, 3, 4, 5, 6.
- However, the studies mention various oxygen therapy devices such as Venturi masks, nasal prongs, and high-flow nasal cannulae, which are used to deliver oxygen to patients with COPD exacerbation 3, 4, 5.
- The use of oxygen therapy in COPD exacerbation is crucial, and the goal is to maintain an adequate level of arterial oxygenation while avoiding worsening of respiratory acidosis 4, 5.
- Non-invasive ventilation (NIV) is also a standard therapy for patients with COPD exacerbation, and it is supported by clinical practice guidelines 4, 6.
- The management of COPD exacerbation involves a comprehensive approach, including pharmacologic and non-pharmacologic strategies, such as inhaled bronchodilators, systemic steroids, antibiotics, and pulmonary rehabilitation 2, 3.