An evaluation of short-term oxygen therapy: the prescription of oxygen to patients with chronic lung disease hypoxic at discharge from hospital

The provision of domiciliary oxygen to patients hypoxic at hospital dischar ge has been termed short-term oxygen therapy (STOT). This practice appears widespread, although there is a paucity of literature and no evidence-based guidelines. We undertook this audit to examine the prescription of STOT and determine t he proportion fulfilling for long-term oxygen therapy (LTOT) 2 months post- discharge. STOT was defined prospectively: resting PaO(2)less than or equal to7.3 kPa (55mmHg) or PaO2 between 7.3 and 8.0 kPa. (60mmHg) with any of the followin g: clinical evidence of cor pulmonale (pedal oedema or jugular venous diste nsion), ECG evidence of pulmonale, echocardiogram evidence of pulmonary hyp ertension, haematocrit > 0.55 (adapted directly from LTOT criteria). Patien ts were evaluated for LTOT 2 months post-discharge when clinically stable o n optimal medical management. AU referrals to the Auckland Regional Oxygen Service between July 1998 and 1999 were systematically reviewed. The majority 289/405 (71%) of new referrals were for the prescription of ST OT/LTOT in patients with chronic lung disease: 160/289 (55%) derived from h ospitalized patients with the majority 130 (81%) fulfilling criteria for ST OT, median age 73, range 24-96 years. Mean hospital stay was 10.2 days. Two months after discharge 22/127 (17%) of STOT patients had died, comparable with 4/22 (18%) not fulfilling criteria for STOT. A total of 123 patients w ere assessed for LTOT at 2 months; 76 (62%) fulfilled criteria for LTOT. The prescription of oxygen at hospital discharge represented a considerable proportion of our referral load. There was a high mortality in the 2-month follow-up period. A significant proportion of STOT patients did not subseq uently fulfill criteria for LTOT. Further prospective studies are required in order to develop evidence-based guidelines.