“Pre-Hospital Oxygen Therapy” by Branson & Johannigman

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Table of Contents

The Problem
The research design and methods
The Results (Findings)
Perspectives of the conclusions
The article’s clinical relevance to the Respiratory Care profession
References

The Problem

The use of oxygen in prehospital care focuses on treating or preventing hypoxemia.

Excess oxygen (hyperoxia) delivery has critical effects on certain patients (Cornet, Kooter, Peters and Smulders, 2012). Hyperoxia can adversely affect patient outcomes. Oxygen delivery to patients without hypoxemia (low level of oxygen in the blood) can lead to adverse outcomes in the presence of hyperoxia. Oxygen is the most commonly delivered and administered to patients after medical and surgical procedures, but it is not necessarily the most commonly prescribed.

The research design and methods

The study is a comprehensive review of current organizational guidelines for oxygen delivery in pre-hospital care and the current evidence from human trials, which demonstrate the safety, efficacy, and complications of pre-hospital oxygen therapy.

The Results (Findings)

General Findings

Prehospital care takes place in unique environments with logistical and educational challenges (Branson and Johannigman, 2013)
Prehospital care requires oxygen therapy for patients with hypoxemia
Oxygen should be titrated to achieve normoxemia
It is important to review and change current practices of oxygen delivery in prehospital care

Specific Findings

Cardiovascular Disease

There are risks of hypoxemia
Further studies are necessary to determine the prehospital oxygen delivery for cardiopulmonary resuscitation, the oxygen level and its measurement

Respiratory Disease

The presence of hypoxemia requires oxygen therapy
Oxygen therapy should be specifically addressed to a given condition

Trauma

Oxygen is necessary in cases of hypoxemia
Oxygen titration to a normal level is required
Hyperoxemia could present challenges because of unexpected outcomes among trauma patients with or without traumatic brain injuries

Other Conditions

Pregnancies require titrated oxygen provided under certain pathophysiology conditions
They also need analysis of oximetry or blood gas

Other conditions

Breathlessness: oxygen therapy does not eliminate breathlessness in non-hypoxemic patients
Sickle Cell Crisis: oxygen therapy is necessary in conditions of hypoxemia
Carbon Monoxide Poisoning

Oxygen delivery is necessary in carbon monoxide poisoning

One hundred percent oxygen reduces the half-life of carboxyhemoglobin from 4 or 5 hours to 40 minutes

Perspectives of the conclusions

The study presents an overall account of the use of oxygen therapy in prehospital care in a short and concise manner. It shows that:

Excess oxygen usages occur due to a common belief that it is non-toxic over short exposures
There are logistic challenges in oxygen delivery
Training challenges have resulted in excess oxygen usages in terms of dosages and indication of conditions
Oxygen requires titration to lessen cases of hypoxemia and eliminate hyperoxemia except in conditions of carbon monoxide poisoning
Overall, the conclusion captures the aim of the study clearly and precisely.

The article’s clinical relevance to the Respiratory Care profession

The article highlights the need to review current practices of oxygen delivery in prehospital care based on evidence presented. It shows that the prehospital care environment has logistical challenges. Nurses need continued training in prehospital care conditions. The article dispels the common myth that oxygen is non-toxic by showing that hyperoxia can negatively affect outcome. Best practice requires oxygen titration.

References

Branson, R. D., and Johannigman, J. A. (2013). Pre-Hospital Oxygen Therapy. Respiratory Care, 58(1), 86-97. .

Cornet, A. D., Kooter, A. J., Peters, M. J., and Smulders, Y. M. (2012). Supplemental oxygen therapy in medical emergencies: more harm than benefit? Arch Intern Med., 172(3), 289-290.

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