German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients

Abstract

<b><i>Background:</i></b> Oxygen (O<sub>2</sub>) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. <b><i>Methods:</i></b> A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System (“The Oxford 2011 Levels of Evidence”) was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. <b><i>Results:</i></b> The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O<sub>2</sub> therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. <b><i>Conclusion:</i></b> This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.

Eine Querschnittsuntersuchung zur Qualität der Sauerstofftherapie in drei deutschen Krankenhäusern

“…Weiterhin wurden auch Resorptions-Atelektasen und koronare Vasokonstriktion nach einem Myokardinfarkt beschrieben [13,14] Um die Behandlungsbedürftigkeit einer Hypoxämie einschätzen zu können, müssen die vollständigen Vitalzeichen erhoben werden. Zudem muss geklärt werden, ob es sich um einen akuten oder chronischen Zustand handelt und welche Begleiterkrankungen vorliegen [8]. Die aktuelle Evidenzlage spricht für einen Zielbereich der akuten O2-Therapie in der pulsoxymetrischen Messung von 92-96 % bei spontanatmenden Patienten ohne Hyperkapnie-Risiko sowie bei beatmeten Patienten und für einen Zielbereich von 88-92 % für Patienten mit Hyperkapnierisiko [1,8].…”

Vivência de fisioterapeutas com pacientes hospitalizados sob oxigenoterapia

“…De acordo com as diretrizes clínicas de Alhazzani, et al, (2020) 22 e Gottlieb, et al, (2022) 15 os mesmos princípios e as faixas alvo de oxigenoterapia que se aplicam a outros pacientes hipoxê-micos também se aplicam a adultos com doenças infecciosas transmissíveis por aerossóis. Em relação à indicação de dispositivos para esse público inicialmente, a máscara de Venturi era contraindicada devido ao risco aumentado de aerossolização e contaminação dos profissionais 23 , o que pôde ser percebido em nossos achados, pois a maioria dos profissionais contraindicaram tal dispositivo.…”

Optimizing PO2 during peripheral veno-arterial ECMO: a narrative review

“…The ELSO experts recommend avoiding extracorporeal hypoxemia, but they do not define a threshold value. In critically ill patients without ECMO, it is recommended to maintain S a O 2 above 92% during mechanical ventilation [ 56 ]. Lower limits have even been tolerated in ARDS (S a O 2 ≥ 88%, P a O 2 ≥ 55 mmHg) [ 57 , 58 ].…”