Evaluating the appropriate application of the NEWS2 SpO2 scales in COPD inpatients: A focus on ABG/VBG as primary markers and radiological imaging

• Published in: Clinical medicine (London, England) Vol. 24; p. 100165
• Main Authors: Farman, Fatima, Murad, Awin Mohammed Murad Mohammed, Imdhad, Rhodes, Jayalekshmi, Sangeetha, Dibbeh, Khaled, Punjabi, Minhal, Tun, HayMar, Asfour, Hasan, Singh, Raunak
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.04.2024
• ISSN: 1470-2118
• DOI: 10.1016/j.clinme.2024.100165

COPD remains a leading cause of global mortality, with clinical diagnosis traditionally relying on detecting irreversible airflow obstruction via pulmonary function tests. This audit aimed to improve saturation targeting and oxygen administration accuracy for confirmed COPD patients (to ensure patients are on the correct NEWS2 SpO2 Scale). The study expanded its evaluation to include imaging to assess the usefulness of documented COPD radiographic findings and their correlation with chest infection diagnosis and treatment. This comprehensive approach augments clinical decision-making when selecting the appropriate NEWS2 SpO2 Scale, to improve COPD management. 1. To ascertain the appropriate implementation of NEWS 2 SpO2 Scale in COPD patients, ensuring that those with those without hypercapnic respiratory failure are on Scale 1 (target sats >96%) and those with hypercapnic respiratory failure are on Scale 2 (target sats 88–92%). 2. To assess the usefulness of ABG as a primary marker of respiratory failure, as well as radiological findings in COPD patients. A prospective study was conducted with COPD inpatients on medical wards at Leicester Royal Infirmary. The study comprised two audit cycles conducted in 2023. 23 October 2023). The 1st cycle involved 21 patients, whilst Cycle 2 included 33 patients. Interventions implemented post-Cycle 1 included: raising awareness at departmental meetings, dissemination of educational posters, and upskilling junior doctors through teaching. Correct usage of Scale 1 improved from 72% to 82% and correct usage of Scale 2 improved from 69% to 100%, and overall correct usage improved from 70% to 91%. Following changes implemented during the initial cycle, there was a notable increase in appropriate utilisation of both scale 1 and scale 2 (hypercapnic model) for COPD patients. Whilst ABG is the gold standard for identification of hypercapnic respiratory failure (pCO2 >6.0), other surrogate markers may be used to help select the correct scale e.g. HCO3- levels on a VBG can be useful in patients whom ABG is not feasible or appropriate. Improving identification and documentation of radiographic findings in COPD patients would be helpful to improving COPD management.