Emergency oxygen therapy: from guideline to implementation

Abstract

Educational aimsTo help readers understand the best way to use oxygen when they care for patients with medical emergencies.To encourage best practice in the use of emergency oxygen therapy.To raise awareness of the British Thoracic Society (BTS) guideline for emergency oxygen use.SummaryOxygen is the most commonly used drug in emergency medicine and when used judiciously in the treatment of hypoxaemia it undoubtedly saves life. However, oxygen is often used inappropriately and the dangers of over-oxygenation are unappreciated.In 2008, the first formal guidance on emergency oxygen use was produced by the British Thoracic Society. The guideline is objective, evidence based and peer reviewed, advocating safe use of oxygen by encouraging target saturation levels to be prescribed for each patient, based on a combination of what is believed to be safe and normal or near-normal. In the majority of patients a target saturation range of 94–98% is advised. The importance of recognition of patients at risk of type 2 respiratory failure is highlighted and, in such patients, a target saturation range of 88–92% is recommended.

Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease

“…However, current high-grade evidence for the titration of oxygen therapy to an SpO 2 target of 88-92% provides the evidence on which to base current practice. Clinical champions in health organisations are needed to provide leadership and oversight to ensure that all health practitioners within their service practice evidence-based medicine with the use of oxygen therapy in acute exacerbations of COPD [58,67].…”

Acute exacerbation of chronic obstructive pulmonary disease

“…Целью кислородотерапии является достижение РаО 2 в пределах 55-65 мм рт. ст., сатурация кислородом (SaO2) -88-92 % [84].…”

“…ст. [84]. После ини циации или изменения режима кислородотерапии в течение ближайших 30-60 мин рекомендовано проведение газового анализа артериальной крови для контроля показателей РаСО 2 и рН.…”

Accuracy of Oxygen Flow Delivered by Compressed-Gas Cylinders in Hospital and Prehospital Emergency Care

“…Oxygen therapy is widely used in both hospital and prehospital care. [1][2][3] In 2008, a study showed that, in the United Kingdom, 15-17% of hospitalized patients received oxygen at some point compared to 34% of patients who had been transported by ambulance. 4 In these situations, oxygen therapy is delivered with wallmounted Thorpe tube or oxygen cylinders.…”

“…In 2013, a study highlighted that several thousand deaths could be avoided each year in United Kingdom with controlled oxygen use. 3 The accuracy of oxygen flow is therefore a key. Recent studies have examined the accuracy of Thorpe tubes in clinical situations.…”