Oxygen saturation should be the fifth vital sign: Guidelines


The British Thoracic Society guideline for oxygen use in adults in health care and emergency settings has called for oxygen saturation to be the fifth vital sign.

The updated and expanded guideline said the pulse oximeter should be ‘as ubiquitous as a stethoscope’ and measurement of oxygen saturation in patients as normal ‘as listening to their chest’.

“The availability now of highly portable, low-cost pulse oximeters should make the measurement of oxygen saturation in many clinical scenarios commonplace and used as the ‘fifth vital sign’,” it said.

The BTS guideline reinforces the importance of oxygen being prescribed according to a target saturation range, and monitoring to keep SpO2 within the range.

Professor Greg King, medical director of the Respiratory Investigation Unit at Royal North Shore Hospital, said the concept of the fifth vital sign was close to being incorporated into TSANZ guidelines.

However the BTS and TSANZ documents were largely complementary, he said.

“This guidance is consistent with the intention of our guidelines and applies to all groups who administer acute oxygen therapy. It is a good reminder for people to review their practice and try to implement a change.”

He said ad hoc use of oxygen was rampant and unfortunately the myth that more must be better was ingrained into a generation of health professionals including doctors, nurses and paramedics.

“We have a massive gulf between what we know and recommend and what we practise. Oxygen is an important emergency drug and used ubiquitously. Education is key to the appropriate acute use of oxygen therapy.”

He added that there was a lot of ‘loose practice’ even within respiratory units.

Professor King said the BTS guideline was more specific than the TSANZ document in recommending that a change of oxygen saturation of 3% or more was significant and a trigger for clinical review.

The comprehensive British guideline also includes new areas of guidance on the provision of oxygen in postoperative and perioperative care, endoscopy and other procedures, palliative care settings, by healthcare professionals in patients’ homes and by first responders from voluntary rescue organisations. It said pulse oximetry must be available in all locations where emergency oxygen is used.

The guidance also extends to the use of oxygen mixtures with helium and nitrous oxide, CPAP and high flow nasal cannulae.

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