Abstract
Current NICE guidance recommends hospital admission when SpO2 < 90% but with supplemental oxygen many such patients might be managed at home provided that worsening hypercapnia and respiratory acidosis is excluded.
As part of the NHS Lung Improvement Programme, Sunderland Urgent Care Team (South Tyneside NHS Foundation Trust) set up a six month Pilot to reduce emergency hospital admission by introducing measurement of capillary blood gases (TcABGs) and the urgent provision of oxygen to manage what would have been an admission into a treatable condition at home. Following a clinical assessment, a team of advanced nurse practitioners guided by an operational protocol measured TcABGs in a group of patients with AECOPD who's SpO2 was in the range 85 -89%. Suitable patients were provided with oxygen cylinders delivering oxygen in the range of 2-6 L/min and monitored until oxygenation improved (SpO2 > 90%) and there was clinical recovery. Initially, urgent oxygen provision and ABG measurement proved problematic but 25 patients were recruited. 4 were excluded for breaching protocol (2 TcABGs failed, 1 was acidotic (pH 7.29) and chose to remain at home, 1 had no follow up data). 4 were admitted (2 acidotic, 2 hypoxic on LTOT). The remaining 16 hypoxic (SpO2 86% ± 1) patients improved (SpO2 93% ± 2) with urgent oxygen provision and were managed safely at home but 1 became non compliant. Initial visit times lasted 186.2 ± 80.7 mins with between four and twelve follow up visits until recovery. With urgent oxygen provision, careful selection and monitoring, hospital admission can be avoided even in moderately hypoxic patients with exacerbations of COPD.
- © 2012 ERS