Emergency oxygen use in adult patients: concise guidance

Abstract

-There is considerable controversy concerning the benefits and risks of oxygen treatment in many situations and healthcare professionals receive conflicting advice about safe oxygen use. The British Thoracic Society (BTS) has published up-to-date, evidence-based guidelines for emergency oxygen use in the UK in order to encourage the safe use of oxygen in emergency situations and improve consistency of clinical practice. 1 The purpose of this concise guideline is to summarise the key recommendations, particularly concerning emergency oxygen use in the hospital setting.

Randomised control trial of humidified high flow nasal cannulae versus standard oxygen in the emergency department

“…Dyspnoea or shortness of breath is a common presentation to the EDs. The indications for oxygen therapy are to correct hypoxaemia and alleviate breathlessness . Unassisted oxygen delivery devices include nasal cannulae or face masks and assisted ventilation devices commonly used in ED include non‐invasive ventilation (NIV), such as Bilevel Positive Airway Pressure, Continuous Positive Airway Pressure and invasive ventilation …”

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

“…However, oxygen therapy is an essential supportive treatment to correct hypoxemia and alleviate breathlessness. 1 Oxygen supply via a nasal cannula or non-rebreathing mask is routinely used, but these methods may be inadequate to support patients' increased work of breathing, particularly if they require a high inspiratory flow (range of 30 -120 L/min in acute respiratory failure). 2 Furthermore, variations in F IO 2 occur with conventional oxygen therapy (COT), and delivered F IO 2 depends on oxygen flow and the patient's breathing pattern.…”

Effect of time and day of admission on hospital care quality for patients with chronic obstructive pulmonary disease exacerbation in England and Wales: single cohort study

“…Less than 50% of patients receiving NIV received it within 3 hours of admission with an escalation plan documented in only 28% of cases, while oxygen was prescribed, rather than administered unregulated, in just over half the hypoxic patients despite the recent launch of national oxygen guidelines. 22 Disappointingly similar deficiencies in these areas of care were seen in the 2008 national audit. 23 specialty care Time taken for respiratory specialty review was higher for patients admitted on a Friday and a Saturday than for midweek admissions but was actually the lowest of all for Sunday admissions probably because of the lack of specialty care on weekend days but the availability of posttake specialty triage on Monday mornings.…”

“…Less than 50% of patients receiving NIV received it within 3 hours of admission with an escalation plan documented in only 28% of cases, while oxygen was prescribed, rather than administered unregulated, in just over half the hypoxic patients despite the recent launch of national oxygen guidelines 22. Disappointingly similar deficiencies in these areas of care were seen in the 2008 national audit 23…”