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British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings
  1. B R O'Driscoll,
  2. L S Howard,
  3. J Earis and
  4. V Mak
  5. on behalf of the BTS Emergency Oxygen Guideline Development Group
    1. Department of Respiratory Medicine, Salford Royal Foundation NHS Trust, Salford, UK
    1. Correspondence to Dr BR O'Driscoll; ronan.o'driscoll{at}

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    The full Guideline for oxygen use in adults in healthcare and emergency settings, published in Thorax1 provides an update to the 2008 BTS Emergency oxygen guideline.2 The following is a summary of the recommendations and good practice points. The sections noted to within this summary refer to the full guideline sections.

    Executive summary

    Philosophy of the guideline

    • Oxygen is a treatment for hypoxaemia, not breathlessness. Oxygen has not been proven to have any consistent 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 recommends 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.

    1. Assessing patients

      • For critically ill patients, high concentration oxygen should be administered immediately (table 1 and figure 1) and this should be recorded afterwards in the patient's health record.

      • Clinicians must bear in mind that supplemental oxygen is given to improve oxygenation, but it does not treat the underlying causes of hypoxaemia which must be diagnosed and treated as a matter of urgency.

      • The oxygen saturation should be checked by pulse oximetry in all breathless and acutely ill patients, ‘the fifth vital sign’ (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 rate, blood pressure, temperature and respiratory rate).

      • Pulse oximetry must be available in all locations where emergency oxygen is used. Clinical assessment is recommended if the saturation falls by ≥3% or below the target range …

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