BTS guideline for emergency oxygen use in adult patients

Philosophy of the guidelinec Oxygen is a treatment for hypoxaemia, not breathlessness.(Oxygen has not been shown to have any effect on the sensation of breathlessness in non-hypoxaemic patients.)c The essence of this guideline can be summarised simply as a requirement for oxygen to be prescribed according to a target saturation range and for those who administer oxygen therapy to monitor the patient and keep within the target saturation range.c The guideline suggests aiming to achieve normal or near-normal oxygen saturation for all acutely ill patients apart from those at risk of hypercapnic respiratory failure or those receiving terminal palliative care. Assessing patientsc For critically ill patients, high concentration oxygen should be administered immediately (table 1 and fig 1) and this should be recorded afterwards in the patient’s health record.c Oxygen saturation, ”the fifth vital sign”, should be checked by pulse oximetry in all breathless and acutely ill patients (supplemented by blood gases when necessary) and the inspired oxygen concentration should be recorded on the observation chart with the oximetry result.(The other vital signs are pulse, blood pressure, temperature and respiratory rate).c Pulse oximetry must be available in all locations where emergency oxygen is used.c All critically ill patients should be assessed and monitored using a recognised physiological track and trigger system. Oxygen prescriptionc Oxygen should be prescribed to achieve a target saturation of 94-98% for most acutely ill patients or 88-92% for those at risk of hypercapnic respiratory failure (tables 1-3).c The target saturation should be written (or ringed) on the drug chart (guidance in fig 1). Oxygen administrationc Oxygen should be administered by staff who are trained in oxygen administration.c These staff should use appropriate devices and flow rates in order to achieve the target saturation range (fig 2).Monitoring and maintenance of target saturation c Oxygen saturation and delivery system should be recorded on the patient’s monitoring chart alongside the oximetry result.c Oxygen delivery devices and flow rates should be adjusted to keep the oxygen saturation in the target range.c Oxygen should be signed for on the drug chart on each drug round.Weaning and discontinuation of oxygen therapy c Oxygen should be reduced in stable patients with satisfactory oxygen saturation.c Oxygen should be crossed off the drug chart once oxygen is discontinued.Oxygen is one of the most widely used drugs and is used across the whole range of specialities.The Guideline Group recognises that many clinicians will initially wish to read an abbreviated version of this guideline which is available to download from the BTS website (www.brit-thoracic.org.uk). SUMMARY OF KEY RECOMMENDATIONS FOR EMERGENCY OXYGEN USEAchieving desirable oxygen saturation ranges in acute illness (sections 6.7 and 6.8)Oxygen therapy in pregnancy (section 8.13.3) 14.Women who suffer from major trauma, sepsis or acute illness during pregnancy should receive the same oxygen therapy as any other seriously ill patients, with a target oxygen saturation of 94-98%.The same target range should be applied to women with hypoxaemia due to acute complications of pregnancy (eg, collapse related to amniotic fluid embolus, eclampsia or antepartum or postpartum haemorrhage). [Grade D]Oxygen use in specific illnesses c See tables 1-4 and figs 1 and 2 (and section 8 in main text) c Critical illness requiring high levels of supplemental oxygen: see table 1 and section 8 c Serious illness requiring moderate levels of supplemental oxygen if a patient is hypoxaemic: see table 2 and section 8. c COPD and other conditions requiring controlled or low-dose oxygen therapy: see table 3 and section 8. c Conditions for which patients should be monitored closely but oxygen therapy is not required unless the patient is hypoxaemic: see table 4 and section 8. BTS guideline