Conclusions and policy implications
This randomised controlled trial found that titrated
oxygen treatment in the prehospital setting resulted
in a 78% reduction in the risk of in-hospital respiratory
failure and subsequent mortality, compared with high
flow oxygen treatment, and a decreased risk of hypercapnia and respiratory acidosis for patients with an acute exacerbation of chronic obstructive pulmonary
disease. Our findings provide the first high quality evidence from a randomised controlled trial for the development of universal guidelines and support the British
Thoracic Society’s recent guidelines on acute oxygen
treatment, which recommend that oxygen should be
administered only at concentrations sufficient to maintain adequate oxygen saturations. Although our findings may need to be confirmed in larger studies across
other health systems, implementation of the new
guidelines will now be easier. However, resources for
an aggressive campaign of education will still be
needed to change the “more is better” oxygen culture
that may ignore the potential dangers of hyperoxia.