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      International Journal of COPD (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on pathophysiological processes underlying Chronic Obstructive Pulmonary Disease (COPD) interventions, patient focused education, and self-management protocols. Sign up for email alerts here.

      39,063 Monthly downloads/views I 2.893 Impact Factor I 5.2 CiteScore I 1.16 Source Normalized Impact per Paper (SNIP) I 0.804 Scimago Journal & Country Rank (SJR)

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      Automated oxygen titration and weaning with FreeO 2 in patients with acute exacerbation of COPD: a pilot randomized trial

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          Abstract

          Introduction

          We developed a device (FreeO 2) that automatically adjusts the oxygen flow rates based on patients’ needs, in order to limit hyperoxia and hypoxemia and to automatically wean them from oxygen.

          Objective

          The aim of this study was to evaluate the feasibility of using FreeO 2 in patients hospitalized in the respiratory ward for an acute exacerbation of COPD.

          Methods

          We conducted a randomized controlled trial comparing FreeO 2 vs manual oxygen titration in the respiratory ward of a university hospital. We measured the perception of appropriateness of oxygen titration and monitoring in both groups by nurses and attending physicians using a Likert scale. We evaluated the time in the target range of oxygen saturation (SpO 2) as defined for each patient by the attending physician, the time with severe desaturation (SpO 2 <85%), and the time with hyperoxia (SpO 2 >5% above the target). We also recorded length of stay, intensive care unit admissions, and readmission rate. Fifty patients were randomized (25 patients in both groups; mean age: 72±8 years; mean forced expiratory volume in 1 second: 1.00±0.49 L; and mean initial O 2 flow 2.0±1.0 L/min).

          Results

          Nurses and attending physicians felt that oxygen titration and monitoring were equally appropriate with both O 2 administration systems. The percentage of time within the SpO 2 target was significantly higher with FreeO 2, and the time with severe desaturation and hyperoxia was significantly reduced with FreeO 2. Time from study inclusion to hospital discharge was 5.8±4.4 days with FreeO 2 and 8.4±6.0 days with usual oxygen administration ( P=0.051).

          Conclusion

          FreeO 2 was deemed as an appropriate oxygen administration system by nurses and physicians of a respiratory unit. This system maintained SpO 2 at the target level better than did manual titration and reduced periods of desaturation and hyperoxia. Our results also suggest that FreeO 2 has the potential to reduce the hospital length of stay.

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          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

          R A Pauwels, A Buist, P. Calverley … (2001)
          Article 0 comments Cited 800 times – based on 0 reviews     Review now
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            Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

            Albert Boonstra, Manda Broekhuis (2010)
            Background The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options. Methods A systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information. Results The study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers. Conclusions Despite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined.
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              Systematic review of studies of the effect of hyperoxia on coronary blood flow.

              Hamish Farquhar, Mark Weatherall, Meme Wijesinghe … (2009)
              International guidelines recommend the routine use of oxygen in the initial treatment of myocardial infarction, yet it is uncertain what effect this might have on physiologic and clinical outcomes. We undertook a systematic search of Medline, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL using the key words "oxygen," "coronary blood flow," "hyperoxia," and "coronary circulation" to identify human studies involving a measure of coronary blood flow while breathing oxygen and room air. The primary outcome measure was coronary blood flow; secondary outcomes included coronary vascular resistance and myocardial oxygen consumption. From 2,072 potential publications, there were 6 studies from 4 publications that met the inclusion criteria, with 6 healthy subjects and 61 subjects with cardiac disease. It was not possible to undertake a meta-analysis due to methodological limitations. In the 6 studies, high-concentration oxygen therapy resulted in hyperoxia, with a range in mean Pao(2) of 273 to 425 mm Hg. Hyperoxia caused a significant reduction in coronary blood flow (mean change -7.9% to -28.9%, n = 6 studies). Hyperoxia caused a significant increase in coronary vascular resistance (mean change 21.5% to 40.9%, n = 4 studies) and a significant reduction in myocardial oxygen consumption (mean change -15.3% to -26.9%, n = 3 studies). Hyperoxia from high-concentration oxygen therapy causes a marked reduction in coronary blood flow and myocardial oxygen consumption. These physiologic effects may have the potential to cause harm and are relevant to the use of high-concentration oxygen therapy in the treatment of cardiac and other disorders.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis
                Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis
                Journal ID (publisher-id): International Journal of COPD
                Title: International Journal of Chronic Obstructive Pulmonary Disease
                Publisher: Dove Medical Press
                ISSN (Print): 1176-9106
                ISSN (Electronic): 1178-2005
                Publication date Collection: 2016
                Publication date (Electronic): 24 August 2016
                Volume: 11
                Pages: 1983-1990
                Affiliations
                [1 ]Research Centre
                [2 ]Biostatistics Department, Quebec Heart and Lung Institute, Laval University
                [3 ]Emergency Medicine, Hôtel-Dieu de Lévis, Laval University, Quebec City, QC, Canada
                Author notes
                Correspondence: François Lellouche, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Quebec City G1V 4G5, QC, Canada, Tel +1 418 656 8711 ext 3298, Email francois.lellouche@ 123456criucpq.ulaval.ca
                Article
                Publisher ID: copd-11-1983
                DOI: 10.2147/COPD.S112820
                PMC ID: 5003517
                PubMed ID: 27601891
                SO-VID: dff24a09-f802-49db-930e-f2c2e5473823
                Copyright © © 2016 Lellouche et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Respiratory medicine
                Keywords: oxygen inhalation therapy,technological innovations,hypoxia,hyperoxia,closed-loop
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: oxygen inhalation therapy, technological innovations, hypoxia, hyperoxia, closed-loop

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