Critical illnesses requiring high levels of supplemental oxygen (section 8.10)
| The initial oxygen therapy is a reservoir mask at 15 l/min pending the availability of reliable oximetry readings. For patients with spontaneous circulation and a reliable oximetry reading, it may quickly become possible to reduce the oxygen dose whilst maintaining a target saturation range of 94–98%. If oximetry is unavailable, continue to use a reservoir mask until definitive treatment is available. Patients with COPD and other risk factors for hypercapnia who develop critical illness should have the same initial target saturations as other critically ill patients pending the results of blood gas results after which these patients may need controlled oxygen therapy with target range 88–92% or supported ventilation if there is severe hypoxaemia and/or hypercapnia with respiratory acidosis. | ||
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| Additional comments | Recommendations | |
| Cardiac arrest or resuscitation | Refer to resuscitation guidelines for choice of delivery device during active resuscitation. Give highest possible inspired oxygen concentration during CPR until spontaneous circulation has been restored. | Recommendation E1 |
| Shock, sepsis, major trauma, drowning, anaphylaxis, major pulmonary haemorrhage, status epilepticus | Also give specific treatment for the underlying condition. | Recommendations E2–E4 |
| Major head injury | Early tracheal intubation and ventilation if comatose. | Recommendation E5 |
| Carbon monoxide poisoning | Give as much oxygen as possible using a bag-valve mask or reservoir mask. Check carboxyhaemoglobin levels. A normal or high oximetry reading should be disregarded because saturation monitors cannot differentiate between carboxyhaemoglobin and oxyhaemoglobin, owing to their similar absorbances. The blood gas PO2 will also be normal in these cases (despite the presence of tissue hypoxia). | Recommendation E6 |
COPD, chronic obstructive pulmonary disease; CPR, cardiopulmonary resuscitation; PO2, oxygen tension blood gases.