Oxygen is a drug: guidelines

New TSANZ guidelines on the use of oxygen in acute medical settings aim to bring evidence-based clarity to a “currently confusing clinical area”, experts say.

Writing in the MJA Professor E. Haydn Walters, from the University of Tasmania, and Associate Professor Greg King from the Woolcock Institute of Medical Research in Sydney say the guidelines are based on British Thoracic Society guidelines but differ in some practical ways to avoid the worst “compromises” made to achieve professional consensus in the United Kingdom.

The aim of the guidelines, say Walters and King, is to “formalise the use of oxygen as a drug that is rationally and precisely prescribed — that is, with a specified mode of delivery (our practical preference is by nasal cannulae), flow rate (or FiO2) and rational target range of oxygen saturation”.

“The latter would be 88%–92% in patients with chronic obstructive pulmonary disease or other chronic respiratory conditions in which carbon dioxide retention is a possibility.

For most other medical conditions requiring oxygen supplementation the guidelines advocate a range of 92%–96%.

This range was “probably unnecessarily high” but was the Australian guidelines’ compromise “so as not to cause controversy,” they maintained.

“This range does allow both deterioration and improvement in the patient’s condition to be detected easily and in a timely way, rather than being masked by overoxygenation,” they added.

The TSANZ guidelines will shortly be published in the journal, Respirology, but have already been endorsed by the Board of the TSANZ and a wide range of other professional medical, nursing and allied health bodies.

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