BTS guideline for emergency oxygen use in adult patients
- 1Department of Respiratory Medicine, Salford Royal University Hospital, Salford, UK
- 2Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- 3Southend University Hospital, Westcliff on Sea, Essex, UK
- Dr B R O’Driscoll, Department of Respiratory Medicine, Salford Royal University Hospital, Stott Lane, Salford M6 8HD, 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.
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.
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).
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).
Monitoring and maintenance of target saturation
Oxygen saturation and delivery system should be recorded on the patient’s monitoring chart …