Chest
Volume 68, Issue 4, October 1975, Pages 486-492
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Clinical Investigations
Long-term Results of Continuous Oxygen Therapy at Sea Level

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Twelve patients with hypoxemia associated with severe chronic obstructive pulmonary disease were treated with continuous portable oxygen therapy and have been followed up for a mean period of 25.2 months at sea level. Pulmonary function testing has revealed no further significant deterioration at long-term follow-up (17 months). After oxygen therapy was initiated, arterial carbon dioxide tension increased slightly, but decreased to pretreatment levels when patients were allowed to breathe room air. The electrocardiogram, which was unchanged at one month, has shown some reversal of cor pulmonale in five patients. Six patients have died, yielding a 56 percent survival rate at two-and-one-half years by the life table analysis. Five patients were autopsied, with possible oxygen toxicity being present in only one. The quality of life in our patients was improved and was especially represented by a reduction in hospital admissions for respiratory illness. We believe that continuous oxygen therapy is beneficial and worthwhile economically in certain patients.

Section snippets

METHODS AND MATERIALS

We conducted this study and used the criteria for selection of patients according to a protocol we have previously described.5 Briefly, we considered for continuous oxygen therapy any patient with severe COPD, a resting arterial oxygen tension (PaO2) of less than 55 mm Hg while under optimal therapy, and a further decrease in their PaO2 values during treadmill exercise. Administration of 2 liters per minute of oxygen by nasal cannula had to improve the patient's hypoxemia and exercise tolerance.

RESULTS

The group receiving continuous oxygen consisted of 12 men patients with a mean age of 54.9 (±16.5 years, standard deviation). The mean duration of oxygen therapy has been 25.2 months with a range of 4 to 40 months.

DISCUSSION

It is our contention that the expense and demands on physician time to administer continuous oxygen are worthwhile in certain severely ill patients with COPD. If the relatively rapid deterioration in pulmonary function, noted in earlier stages of disease,1, 2 pertained in these patients, such an effort would not be as feasible. Indeed, we noted no significant deterioration in FEV1, FVC, MVV, or DlCOss. That the PaCO2 becomes elevated in some patients following oxygen administration is well

APPENDIX

Approximate cost analysis at Shands Teaching Hospital for 12-day hospitalization for respiratory failure.

Empty CellIntensive Care Unit (4 days)Ward (semiprivate) (8 days)
A. Physician fee
 Day 1$ 93.50
 Days 2-4124.50
 Days 5-12$ 208.00
B. Bed fee (including nursing)700.00520.00
C. Additional charges (drugs, x-ray, diagnostic tests, consultation)600.00400.00
$1,518.00$1,128.00
Total for hospitalization$2,646.00
Approximate fee per day$ 220.00
Fee for 14.8-day hospitalization$3,260.00
Cost from Coastal

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    Manuscript received January 10; revision accepted March 17.

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