COPD

Swim between the oxygen flags: guidelines

Wednesday, 28 Oct 2015


More is not better when it comes to delivering oxygen to patients in acute medical settings is the key message of new TSANZ guidelines released in full this week

As reported by the limbic in August, the guidelines aim to bring evidence-based clarity to a “currently confusing clinical area”.

In an article 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 said  the guidelines “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 said.

“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.

Commenting on the guidelines, dubbed swimming between the flags, Thoracic Society President Professor Peter Gibson said: “More is not better when it comes to delivering oxygen to ill or distressed patients. These guidelines are evidence based best practice and should be utilised by all health care professionals who use oxygen therapy with patients.”

While the Thoracic Society of Australia and New Zealand (TSANZ) Oxygen Guideline recommendations are similar to the BTS 2015 Oxygen Guidelines there are a number of key differences, the guideline authors noted.

These included the general target oxygen saturation range (92–96% vs 94–98%) and the algorithms for emergency use of oxygen including greater emphasis on titration of oxygen administered via nasal cannulae.

For a free full text copy of the guidelines click here. 

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