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Who will benefit from tracheostomy ventilation in motor neuron disease?

2011; BMJ; Volume: 66; Issue: 11 Linguagem: Inglês

10.1136/thoraxjnl-2011-200728

1468-3296

J M Shneerson,

Healthcare Decision-Making and Restraints

high-concentration oxygen therapy causes a clinically significant increase in PtCO 2 and they recommended the use of a titrated oxygen regime in the treatment of severe asthma.These results mirror those of a similar study performed recently in patients with COPD. 9 In this randomised, controlled, prehospital study, participants allocated to titrated oxygen therapy were significantly less likely to have respiratory acidosis (mean difference in pH 0.12; SE 0.05; p¼0.01; n¼38) or hypercapnoea (mean difference in PaCO 2 À33.6 mm Hg; SE 16.3; p¼0.02; n¼39) than patients receiving high-concentration oxygen.Treatment with titrated oxygen was also associated with a 58% reduction in mortality, the primary outcome in this study.As asthma and COPD are prevalent diseases in the Western world, and acute exacerbations of either are associated with an increased risk of death, it is beholden to health professionals to ensure that they do not contribute to this outcome.We now have strong evidence to support the BTS guidelines on emergency oxygen use, which recommend that it be approached in the same way as any other drug, recognising that adverse outcomes may eventuate from either inappropriately low or high concentrations.Should the guidelines be revised in the light of this new evidence to better align recommendations with the philosophy of keeping arterial oxygen saturations 'within the target saturation range' that aim to 'achieve normal or near-normal oxygen saturation' and move away from any suggestion that high-concentration oxygen should be administered in the absence of objective evidence of a physiological need?With the advent of lowcost portable oxygen saturation monitors, surely it is time we followed the guideline exhortations to measure the fifth vital sign, as in the words of Willy Wonka 'it's the only way if you want it just right'.