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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