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The National Early Warning Score 2 (NEWS2) in patients with hypercapnic respiratory failure

Williams, B; (2019) The National Early Warning Score 2 (NEWS2) in patients with hypercapnic respiratory failure. Clinical Medicine , 19 (1) pp. 94-95. 10.7861/clinmedicine.19-1-94. Green open access

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Abstract

The National Early Warning Score (NEWS) was devised to standardise and improve the detection of, and response to, clinical deterioration in patients with acute illness. The original NEWS1 was released in 2012 and has been widely implemented across the NHS and in other healthcare settings globally. The NEWS has now been endorsed by NHS England and NHS Improvement as the single early warning score to be used by all acute hospitals and ambulance services, and it is anticipated that all NHS hospitals in England will be using the NEWS by 2019. It was always anticipated that the NEWS would evolve, based on user experience and feedback, and in December 2017 the NEWS2 was released,2 containing important refinements. One of these changes related to the safer use of oxygen in patients with chronic hypercapnic respiratory failure (HCRF), most commonly seen in some patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). For such patients, the recommended oxygen saturation range is 88–92% and these patients are at risk of rapidly worsening hypercapnia and death if too much oxygen is delivered.3 Concern had been expressed that the original NEWS automatically generated a high score for patients with HCRF due to their hypoxia, prompting use of supplemental oxygen (even though their SpO2 may be in the desired range), leading to frequent alerts and ultimately decisions to override the score or apply ad hoc adjustments. There was concern that the chronically high score in patients with HCRF might encourage the inappropriate use of additional supplemental oxygen in an attempt to reduce the NEWS score by increasing oxygen saturations above the recommended range for these patients.4,5 After much discussion and consultation with the British Thoracic Society and others, a new scoring SpO2 scale (scale 2) was added to the NEWS2 chart that was specifically designed for use only in patients with documented HCRF, explicitly noting that most acutely ill patients with AECOPD will not present with HCRF.2 Supporting this change, audits of hospital care had shown that administration of high-flow oxygen, rather than titrated oxygen, to patients with AECOPD increases mortality, hospital length of stay, requirement for ventilation and admission to higher-dependency care. In contrast, the use of appropriately titrated oxygen resulted in less acidosis and reduced mortality.6–10

Type: Article
Title: The National Early Warning Score 2 (NEWS2) in patients with hypercapnic respiratory failure
Open access status: An open access version is available from UCL Discovery
DOI: 10.7861/clinmedicine.19-1-94
Publisher version: https://doi.org/10.7861/clinmedicine.19-1-94
Language: English
Additional information: This version is the version of record. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, ACUTE EXACERBATIONS, OXYGEN, COULD, RISK, COPD
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10116246
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