ThoracicSociety ofAustralia andNewZealand oxygen guidelines for acute oxygen use in adults: ‘Swimming between the flags’

Abstract

The purpose of the Thoracic Society of Australia and New Zealand guidelines is to provide simple, practical evidence-based recommendations for the acute use of oxygen in adults in clinical practice. The intended users are all health professionals responsible for the administration and/or monitoring of oxygen therapy in the management of acute medical patients in the community and hospital settings (excluding perioperative and intensive care patients), those responsible for the training of such health professionals, and both public and private health care organizations that deliver oxygen therapy.

High flow or titrated oxygen for obese medical inpatients: a randomised crossover trial

“…There is also evidence that administering high concentration oxygen may increase Paco 2 in patients with other respiratory conditions, such as acute asthma, 4 ‐ 6 community‐acquired pneumonia, 7 and stable obesity hypoventilation syndrome (OHS) 8 . ‐ 12 Guidelines therefore recommend that oxygen therapy be titrated to a target Spo 2 range to avoid the risks of both hypoxaemia and hyperoxaemia 13 , 14 …”

“…To assess the physiological response, we continuously monitored transcutaneous carbon dioxide tension (Ptco 2 ), a non‐invasive validated measure of Paco 2 16 . ‐ 18 Our hypothesis was that high concentration oxygen therapy would increase Ptco 2 to a significantly greater extent than an oxygen regimen in which administration, if required, is titrated to achieve an Spo 2 target of 88–92%, as recommended when treating patients with conditions associated with chronic respiratory failure 13 , 14 …”

Oxygen therapy for medical patients

“…These target ranges are a step change downwards from the 2008 British Thoracic Society guideline (target range 94-98%) and the 2015 Thoracic Society of Australia and New Zealand guideline (target range 92-96%) 45. Although technically simple to deliver, these recommendations will require a shift in culture—away from oxygen as a friend, to treating oxygen as any other clinical intervention, requiring consideration and careful supervision.…”

Beneficial effects of rapid introduction of adaptive servo-ventilation in the emergency room in patients with acute cardiogenic pulmonary edema

“…Fourth, it is unknown whether FiO 2 in both groups could be completely matched. However, oxygen concentration in the conventional group was presumably above 60% [27,28], and that in the ASV group was also presumably approximately 60% [18].…”