Tuesday, October 30, 2018

Oxygen supplementation should be used conservatively

Supplemental oxygen is not always indicated for acutely ill patients and giving extra oxygen to hospital patients with normal oxygen levels increases mortality, according to new recommendations published online October 24, 2018 in the BMJ, which recommends conservative use of oxygen supplementation.

·         The expert panel makes a strong recommendation that if supplemental oxygen is administered, a maximum SpO2 of 96% should be ensured. Oxygen therapy should be stopped y in acutely ill medical and surgical patients already receiving oxygen therapy, with a saturation of 96% or higher.

·         For patients with acute stroke or myocardial infarction, the guidelines recommend against starting oxygen therapy when levels are between 90% and 92% saturation.

·         Oxygen therapy should not be started when levels are at or above 93% saturation.

·         For most patients, a target of 90-94% saturation is reasonable and is low enough to avoid harm.

·         The ideal oxygen saturation at which to start oxygen therapy is uncertain, but is probably 90% or lower.

·         A lower target (such as SpO2 88-92%) may be useful in patients at risk of hypercapnic respiratory failure e.g. Chronic obstructive pulmonary disease (COPD), obesity hypoventilation, neuromuscular respiratory diseases, obstructive sleep apnea (OSA), decreased central respiratory drive such as sedative overdose, stroke, encephalitis.

·         A higher target such as SpO2 approaching 100% may help patients with carbon monoxide poisoning, cluster headaches, sickle cell crisis, pneumothorax

·         In all cases, the minimum amount of oxygen necessary is recommended.

·         Clearer information may reduce anxiety and improve patient satisfaction in patients where oxygen is needed.

(Source: BMJ, Eurekalert)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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