Serious illnesses requiring moderate levels of supplemental oxygen if the patient is hypoxaemic
| Section 8.11 | ||
| The initial oxygen therapy is nasal cannulae at 2–6 L/min (preferably) or simple face mask at 5–10 L/min unless stated otherwise. For patients not at risk of hypercapnic respiratory failure who have saturation below 85%, treatment should be started with a reservoir mask at 15 L/min and the recommended initial oxygen saturation target range is 94–98%. If oximetry is not available, give oxygen as above until oximetry or blood gas results are available. Change to reservoir mask if the desired saturation range cannot be maintained with nasal cannulae or simple face mask (and ensure that the patient is assessed by senior medical staff). If these patients have coexisting COPD or other risk factors for hypercapnic respiratory failure, aim at a saturation of 88–92% pending blood gas results but adjust to 94–98% if the PCO2 is normal (unless there is a history of previous hypercapnic respiratory failure requiring NIV or IMV) and recheck blood gases after 30–60 min, see table 4. |
| Additional comments | Recommendations | |
|---|---|---|
| Acute hypoxaemia (cause not yet diagnosed) | Reservoir mask at 15 L/min if initial SpO2 below 85%, otherwise nasal cannulae or simple face mask Patients requiring reservoir mask therapy need urgent clinical assessment by senior staff. | Recommendations D1–D3 |
| Acute asthma pneumonia lung cancer | Recommendations F1–F3 | |
| Deterioration of lung fibrosis or other interstitial lung disease | Reservoir mask at 15 L/min if initial SpO2 below 85%, otherwise nasal cannulae or simple face mask | Recommendation F4 |
| Pneumothorax | Needs aspiration or drainage if the patient is hypoxaemic. Most patients with pneumothorax are not hypoxaemic and do not require oxygen therapy. Use a reservoir mask at 15 L/min if admitted for observation. Aim at 100% saturation. (Oxygen accelerates clearance of pneumothorax if drainage is not required.) | Recommendations F5–F6 |
| Pleural effusions | Most patients with pleural effusions are not hypoxaemic. If hypoxaemic, treat by draining the effusion as well as giving oxygen therapy. | Recommendation F7 |
| Pulmonary embolism | Most patients with minor pulmonary embolism are not hypoxaemic and do not require oxygen therapy. | Recommendation F8 |
| Acute heart failure | Consider CPAP or NIV in cases of pulmonary oedema. | Recommendations F9–F10 |
| Severe anaemia | The main issue is to correct the anaemia. Most anaemic patients do not require oxygen therapy. | Recommendations F11–12 |
| Postoperative breathlessness | Management depends on underlying cause. | Recommendation J1 |
COPD, chronic obstructive pulmonary disease; CPAP, continuous positive airway pressure; IMV, invasive mechanical ventilation; NIV, non-invasive ventilation; PCO2, arterial or arterialised carbon dioxide tension; SpO2, arterial oxygen saturation measured by pulse oximetry.