22, 95% CI 0.05 to 0.9]). The ITT analysis did not demonstrate between-group differences in the secondary outcomes. Conclusion: In patients with a suspected acute exacerbation of COPD, using titrated oxygen to maintain SpO2 between 88% and 92% reduced the risk of mortality by 58%. Physiotherapists working in acute care should strive to ensure that these patients are

not treated with high-flow oxygen. Idelalisib clinical trial There is an increased risk of hypercarbia (Plant et al 2000) associated with the use of high levels of oxygen therapy in patients with COPD. High levels of oxygen are reported to cause increased ventilation perfusion DZNeP mismatch (Sassoon et al 1987). National (McKenzie et al 2010) and international (O’Driscoll et al 2008) guidelines for the management of COPD recommend the controlled delivery of oxygen following an acute exacerbation of COPD with a target arterial oxygen saturation ranging between 88% and 92% (O’Driscoll et al 2008). The trial by Austin et al (2010)

provides the first Level 1 evidence that the pre-hospital short-term administration (45 minutes) of a high fraction of inspired oxygen during an acute exacerbation of COPD is associated with worse outcomes that include hypercarbia, respiratory

acidosis, and increased Unoprostone mortality. Of note, the average partial pressure of arterial oxygen in the titrated oxygen therapy group was 80 mmHg, in both the intention to treat and the protocol groups, which is considered excessive (O’Driscoll et al 2008), but this partial pressure still led to significant improvements in patient outcome. Some authors recommend accepting an arterial saturation above 85% (New 2006) as a means of achieving better outcomes, but this requires appropriate investigation. Titrated oxygen therapy to achieve arterial saturation of between 88% and 92% should be the goal of therapy by physiotherapists who care for patients during acute exacerbations of COPD. The close monitoring of changes in ventilation (carbon dioxide) in response to the delivery of oxygen therapy is also recommended. Further research is required to investigate the impact of oxygen therapy on respiratory function in patients during an acute exacerbation of COPD. “
“Summary of: Suarez-Almazor M, et al (2010) A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication. Arthritis Care Res 62: 1229–1236. [Prepared by Kåre Birger Hagen, CAP Editor.