OBJECTIVE: To investigate the effect of oxygen therapy on outcome and on symptomatic hypercapnia. DESIGN: Randomized, controlled, single-blind study. SETTING: Multidisciplinary intensive care unit of a university teaching hospital. PATIENTS: Patients admitted with a clinical diagnosis of an acute exacerbation of chronic obstructive pulmonary disease and a PaO2 < 6.6 kPa (50 mmHg) and PaCO2 > 6.6 kPa (50 mmHg) on air. INTERVENTIONS: Patients received oxygen therapy titrated to increase arterial oxygen tension to > 6.6 kPa (50 mmHg) or > 9 kPa (70 mmHg). Patients in the low-oxygen tension group also received doxapram if they developed an acidosis with pH < 7.2, whereas those in the high-oxygen tension group received doxapram if they developed symptomatic acidosis. Bronchodilator, steroid, and antibiotic therapy was standardized. MEASUREMENTS AND MAIN RESULTS: Two patients in the low-oxygen tension group (n = 17) required mechanical ventilation and another one died. No patients in the high-oxygen group (n = 17) had a poor outcome, but this difference was not significant. No patient in either group became comatose or developed an acute cardiac arrhythmia. CONCLUSIONS: Traditional teaching related to oxygen therapy for hypercapnic patients with an acute exacerbation of chronic obstructive pulmonary disease may be incorrect. A large randomized, controlled study is required to confirm this impression.

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