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Thorax 63:vi1-vi68 doi:10.1136/thx.2008.102947
  • BTS guideline

BTS guideline for emergency oxygen use in adult patients

  1. B R O’Driscoll1,
  2. L S Howard2,
  3. A G Davison3
  1. 1
    Department of Respiratory Medicine, Salford Royal University Hospital, Salford, UK
  2. 2
    Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
  3. 3
    Southend University Hospital, Westcliff on Sea, Essex, UK
  1. Dr B R O’Driscoll, Department of Respiratory Medicine, Salford Royal University Hospital, Stott Lane, Salford M6 8HD, UK; ronan.o'driscoll{at}srft.nhs.uk
  • Received 11 June 2008
  • Accepted 11 June 2008

EXECUTIVE SUMMARY OF THE GUIDELINE

Philosophy of the guideline

  • 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.)

  • 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.

  • 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 patients

  • 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.

  • 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).

  • Pulse oximetry must be available in all locations where emergency oxygen is used.

  • All critically ill patients should be assessed and monitored using a recognised physiological track and trigger system.

Figure 1 Chart 1: Oxygen prescription for acutely hypoxaemic patients in hospital. ABG, arterial blood gas; COPD, chronic obstructive pulmonary disease; Fio2, fraction of inspired oxygen; ICU, intensive care unit; NIV, non-invasive ventilation; Pco2, carbon dioxide tension; Spo2, arterial oxygen saturation measured by pulse oximetry.
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Table 1 Critical illnesses requiring high levels of supplemental oxygen (see section 8.10)

Oxygen prescription

  • 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).

  • The target saturation should be written (or ringed) on the drug chart (guidance in fig 1).

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Table 2 Serious illnesses requiring moderate levels of supplemental oxygen if the patient is hypoxaemic (section 8.11)
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Table 3 COPD and other conditions requiring controlled or low-dose oxygen therapy (section 8.12)

Oxygen administration

  • Oxygen should be administered by staff who are trained in oxygen administration.

  • These staff should use appropriate devices and flow rates in order to achieve the target saturation range (fig 2).

Figure 2 Chart 2: Flow chart for oxygen administration on general wards in hospitals. ABG, arterial blood gas; EPR, electronic patient record; EWS, Early Warning Score; Spo2, arterial oxygen saturation measured by pulse oximetry.

Monitoring and maintenance of target saturation

  • Oxygen saturation and delivery system should be recorded on the patient’s monitoring chart …

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