This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.


NEW ORLEANS — Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute myocardial infarction (AMI) who received invasive ventilation with high-concentration oxygen therapy experienced significant improvements in extubation and mortality rates compared with patients on moderate-concentration oxygen, according to research presented at the CHEST Annual Meeting 2019, held October 19 to 23, in New Orleans, Louisiana.

This randomized and prospective controlled trial was designed to evaluate the efficacy of invasive ventilation with high-concentration oxygen for elderly AECOPD patients (N=87) with complicated AMI who could not receive percutaneous coronary intervention (PCI). Of the included patients, 80 (92%) had congestive heart failure. Patients with shock and malignant arrhythmia were excluded. Participants were divided 1:1:1 into 3 groups to receive conventional oxygen therapy (3-7 L/min via nasal catheter), high-concentration oxygen therapy, or invasive ventilation with pressure-regulated volume control with 2-step fraction of inspired oxygen management. All groups received continuous venous pump heparin sodium (100 IU/kg/d), anti-anxiety medication, and expansion of coronary therapy.

The high-concentration oxygen group experienced a lower occurrence of malignant arrhythmia and a lower 14-day mortality rate compared with the other groups (P <.01), as well as a higher extubation rate compared with the moderate-concentration oxygen group (75.9% vs 44.8%, P =.016). Recurrence rate for MI was 31% (n=9) for the moderate-concentration oxygen group and 6.9% (n=2) in the high-concentration oxygen group (P =.019). No between-group difference was seen in hyperoxia (P >.05)

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The researchers conclude that patients with AECOPD and AMI who cannot undergo PCI could benefit from invasive ventilation with high-concentration oxygen therapy, but further study on the potential effect is needed.

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Reference

Jun J, Sun L, Wang Y, Liu F, Yang G, Han B. Invasive mechanical ventilation with high concentration oxygen therapy for AECOPD patients with acute myocardial infarction. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 958.