COPD

Re-set required on use of oxygen therapy for acute care patients


Australian and New Zealand experts are claiming the scientific high ground on an inconsistency between TSANZ and British Thoracic Society guidelines for acute use of oxygen therapy.

In a letter published recently in the journal Respirology, TSANZ representatives have reiterated their rationale for a target oxygen saturation range of 92-96% instead of the BTS recommendation of 94-98%.

The recommended target range, for adults without COPD or other conditions associated with chronic respiratory failure, allows for rapid identification of either clinical improvement or deterioration.

“In clinical practice, it is likely that the lower SpO2 range of between 92% and 96% will both reduce the unnecessary use of oxygen in patients with adequate oxygen saturations and facilitate the down titration of oxygen therapy better than the higher SpO2 range of 94–98%,” the group wrote.

Co-author Associate Professor Greg King from the Woolcock Institute of Medical Research, said the target range was based on considerations such as oxygen saturation in healthy adults, the variability in pulse oximetry, and the relative risks of hypoxaemia and hyperoxaemia.

“This is a reasonable, realistic and safe target but will require a re-education process and a change from current practice,” he said.

“Certainly in NSW it has major implications as over time we have gone from flagging these patients as being in the yellow zone and considering a clinical review, to giving them all oxygen.”

He said an undue focus on oxygen saturation, rather than the patient’s underlying medical problem, had gradually developed.

In particular, the entrenched culture of using high concentration oxygen therapy to protect against hypoxaemia, risked masking any deterioration in a patient’s condition.

“We don’t need to fiddle with oxygen all the time. If the SpO2 is less than 92% then oxygen needs to be prescribed at a fixed rate up to a maximum target SpO2 of 96%.”

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