From the Guidelines
The most suitable oxygen delivery system for patients with Chronic Obstructive Pulmonary Disease (COPD) is a 24% or 28% Venturi mask or 1–2 L/min from nasal cannulae, aiming for a saturation range of 88–92%. This approach is based on the British Thoracic Society (BTS) guideline for oxygen use in adults in healthcare and emergency settings 1. The guideline recommends medium-concentration masks and nasal cannulae for most patients, but specifies that patients with known significant COPD should receive oxygen from a 24% or 28% Venturi mask or 1–2 L/min from nasal cannulae to achieve the desired saturation range.
Key considerations in oxygen therapy for COPD patients include:
- Maintaining oxygen saturation between 88-92% to prevent hypercapnia while correcting hypoxemia
- Using controlled oxygen therapy with Venturi masks (set at 24-28% oxygen) during COPD exacerbations requiring hospitalization
- Titration of oxygen with regular arterial blood gas monitoring, especially when initiating therapy
- Considering non-invasive ventilation in addition to oxygen therapy for patients with chronic hypercapnic respiratory failure, particularly for use during sleep
It is essential to follow the BTS guideline recommendations to minimize the risk of carbon dioxide retention and ensure optimal oxygen supplementation for COPD patients. The guideline from 1997 2 also emphasizes the importance of careful oxygen titration and monitoring, but the more recent guideline from 2017 1 provides the most up-to-date recommendations for oxygen delivery systems in COPD patients.
From the Research
Oxygen Delivery Systems for COPD Patients
- Non-invasive positive pressure ventilation (NPPV) and high-flow nasal cannula (HFNC) oxygen therapy are two techniques used to deliver oxygen to COPD patients, with NPPV providing positive pressure support without the need for an artificial airway 3.
- HFNC oxygen therapy has several advantages, including the reduction of anatomical dead space, prompt correction of low oxygen levels, and improvement of patients' tolerance 3, 4, 5.
- Venturi masks (VMs) and nasal prongs (NPs) are also used to deliver oxygen to COPD patients, with VMs being recommended over NPs to maintain adequate arterial oxygenation 6.
Comparison of Oxygen Delivery Systems
- A study comparing VMs and NPs found that both devices improved arterial oxygen tension, but VMs were better at maintaining adequate arterial oxygenation over time 6.
- HFNC therapy has been shown to be beneficial for COPD patients, particularly those with hypoxemia, by improving lung mucociliary clearance, washing out upper airway dead space, and generating a low level of positive airway pressure 4, 5.
- A retrospective cohort study found that HFNC treatment was well tolerated in 83% of COPD patients and was associated with improved outcomes in patients without vascular or cardiac co-morbidities 7.
Factors Associated with Successful Oxygen Therapy
- The absence of vascular and cardiac co-morbidities was associated with improved outcomes of HFNC treatment in COPD patients 7.
- The need for in-hospital non-invasive ventilation (NIV) treatment was associated with a higher chance of HFNC failure 7.
- Maximizing the initial arterial oxygen saturation on oxygen by increasing the inspiratory oxygen fraction was found to be important for maintaining adequate arterial oxygenation in COPD patients 6.