COPD and other conditions requiring controlled or low-dose oxygen therapy (section 8.12)
| Prior to availability of blood gases, use a 24% Venturi mask at 2–3 L/min or 28% Venturi mask at 4 L/min or nasal cannulae at 1–2 L/min and aim for an oxygen saturation of 88–92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis. Adjust target range to 94–98% if the PCO2 is normal (unless there is a history of previous NIV or IMV) and recheck blood gases after 30–60 min. | ||
|---|---|---|
| Additional comments | Recommendations | |
| COPD and other conditions causing fixed airflow obstruction (eg bronchiectasis) | May need lower range if acidotic or if known to be very sensitive to oxygen therapy. Ideally use ‘Alert cards’ to guide therapy based on previous blood gas results. Increase Venturi mask flow by up to 50% if respiratory rate is above 30 bpm | Recommendations G1–G2 and section 8.12.1 |
| Exacerbation of cystic fibrosis | Admit to regional CF centre if possible, if not discuss with regional centre or manage according to protocol agreed with regional CF centre. Ideally use ‘alert cards’ to guide therapy. Increase Venturi mask flow by by up to 50% if respiratory rate is above 30 bpm | Recommendations G1, G3 and G6 |
| Neuromuscular disease, neurological condition and chest wall deformity | May require ventilatory support. Risk of hypercapnic respiratory failure | Recommendations G1, G4 and G6 |
| Morbid obesity | Recommendations G1, G5 and G6 | |
CF, Cystic fibrosis; COPD, chronic obstructive pulmonary disease; CPAP, continuous positive airway pressure; IMV, invasive mechanical ventilation; NIV, non-invasive ventilation; PCO2, arterial or arteriolised carbon dioxide tension; SpO2, arterial oxygen saturation measured by pulse oximetry.