Oxygen

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Introduction

Oxygen is a treatment for hypoxaemia and has not been shown to have any effect on breathlessness in non-hypoxaemic patients.

Indications

Adult:

Oxygen should be titrated to achieve oxygen saturations of between 94 – 98%, (or 88 – 92% for COPD patients). These are achieved through the use of different flow rates and oxygen masks.

Paediatric:

All paediatric patients with significant illness or injury should receive oxygen. Newborn resuscitation should ideally be commenced with room air for the first couple of breaths.

Contraindications

Precautions / Notes

If the target saturations cannot be maintained with the nasal cannula or medium concentration mask then change to a non-rebreather oxygen mask.
Oxygen increases the toxicity in paraquat poisoning, target saturations of 88–92%.
Remember that some conditions can affect SpO₂ readings e.g. carbon monoxide poisoning and cold digits

COVID-19 / Febrile Respiratory Illness

Crews are advised to limit the use of oxygen in patients with influenza like symptoms wherever possible to avoid aerosolisation.
Crews are advised to tolerate lower SpO2 than usual in patients with ILI; ≥ 88% is acceptable. Note: It may not be possible to improve SpO2 to an acceptable level within the oxygenation guideline described above.
Recommendations:
- Nasal prongs: 1-4 litres per minute, ideally with surgical mask over the top where possible
- Therapy mask: Maximum 10 litres per minute
- Non-rebreather/high concentration mask: Maximum 15 litres per minute
Crews treating patients who are on home BiPAP/CPAP or with a tracheostomy should don full PPE requirements for aerosol generating procedures (AGP’s) if the presentation is an infective respiratory illness. See PPE requirements.
Always turn the oxygen off first, then remove the nasal prongs/mask from the patient.

Management

Aim for target saturations of between 94 – 98% for critical conditions requiring supplemental oxygen, maintained via bag-valve-mask or reservoir bag.
In patients with COPD or other conditions requiring controlled or low-dose supplemental oxygen aim for target oxygen saturations range of 88 – 92% (or the patient’s prescribed range).
If the patient is hypoxaemic, oxygen saturations of between 94 – 98% should be maintained through the use of a mask or nasal cannulae as appropriate.

At the correct flow rate the following devices will deliver the following approximate FiO2:

Special Considerations

Patients with acute episodes of COPD are at risk of developing carbon dioxide retention if they are given excessive supplemental oxygen. This can cause acidosis and subsequent organ dysfunction.
High oxygen concentrations can lead to increased production of reactive free radicals resulting in cellular damage. This may be responsible for the detrimental effects observed with the use of high flow oxygen in myocardial infarction and stroke.

References

Presentation

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Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

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