Conditions for which patients should be monitored closely but oxygen therapy is not required unless the patient is hypoxaemic (section 8.13)
| If hypoxaemic, the initial oxygen therapy is nasal cannulae at 2–6 L/min or simple face mask at 5–10 L/min unless saturation is below 85% (use reservoir mask) or if at risk from hypercapnia (see below). The recommended initial target saturation range, unless stated otherwise, is 94–98%. If oximetry is not available, give oxygen as above until oximetry or blood gas results are available. If patients have 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 respiratory failure requiring NIV or IMV) and re-check blood gases after 30–60 min, see table 4. | ||
|---|---|---|
| Additional comments | Recommendations | |
| Myocardial infarction and acute coronary syndromes | Most patients with acute coronary artery syndromes are not hypoxaemic and the benefits/harms of oxygen therapy are unknown in such cases. Unnecessary use of high concentration oxygen may increase infarct size. | Recommendation F13 |
| Stroke | Most patients who had stroke are not hypoxaemic. Oxygen therapy may be harmful for non-hypoxaemic patients with mild-moderate strokes. | Recommendation F14 |
| Hyperventilation or dysfunctional breathing | Exclude organic illness. Patients with pure hyperventilation due to anxiety or panic attacks are unlikely to require oxygen therapy. Re-breathing from a paper bag may cause hypoxaemia and is not recommended. | See section 8.13.3 |
| Most poisonings and drug overdoses (see table 1 for carbon monoxide poisoning) | Hypoxaemia is more likely with respiratory depressant drugs, give antidote if available, for example, naloxone for opiate poisoning. Check blood gases to exclude hypercapnia if a respiratory depressant drug has been taken. Avoid high blood oxygen levels in cases of acid aspiration as there is theoretical evidence that oxygen may be harmful in this condition. Monitor all potentially serious cases of poisoning in a level 2 or level 3 environment (high-dependency unit or intensive care unit) | Recommendation F15 |
| Poisoning with paraquat or bleomycin | Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid oxygen unless the patient is hypoxaemic. Target saturation is 85–88%. | Recommendation F16 |
| Metabolic and renal disorders | Most do not need oxygen (Tachypnoea may be due to acidosis in these patients) | Recommendation F17 |
| Acute and subacute neurological and muscular conditions producing muscle weakness | These patients may require ventilatory support and they need careful monitoring which includes spirometry. If the patient's oxygen level falls below the target saturation, they need urgent blood gas measurements and are likely to need ventilatory support. | Recommendation G4 |
| Pregnancy and obstetric emergencies | Oxygen therapy may be harmful to the fetus if the mother is not hypoxaemic. | Recommendations H1–H4 |
COPD, chronic obstructive pulmonary disease; IMV, invasive mechanical ventilation; NIV, non-invasive ventilation; PCO2, arterial or arteriolised carbon dioxide tension, SpO2, arterial oxygen saturation measured by pulse oximetry.