Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: 'Swimming between the flags'

Richard Beasley, Jimmy Chien, James Douglas, Leonie Eastlake, Claude Farah, Gregory King, Rosemary Moore, Janine Pilcher, Michael Richards, Sheree Smith, Haydn Walters, Richard Beasley, Jimmy Chien, James Douglas, Leonie Eastlake, Claude Farah, Gregory King, Rosemary Moore, Janine Pilcher, Michael Richards, Sheree Smith, Haydn Walters

Abstract

The purpose of the Thoracic Society of Australia and New Zealand guidelines is to provide simple, practical evidence-based recommendations for the acute use of oxygen in adults in clinical practice. The intended users are all health professionals responsible for the administration and/or monitoring of oxygen therapy in the management of acute medical patients in the community and hospital settings (excluding perioperative and intensive care patients), those responsible for the training of such health professionals, and both public and private health care organizations that deliver oxygen therapy.

Keywords: adult; guideline; hyperoxia; hypoxia; oxygen; oxygen inhalation therapy.

© 2015 The Authors. Respirology published by Wiley Publishing Asia Pty Ltd on behalf of Asian Pacific Society of Respirology.

Figures

Figure 1
Figure 1
Treatment algorithm for oxygen therapy. Please refer to the text for full recommendations, references and evidence grading.*Such as COPD, obesity hypoventilation syndrome, chest wall deformities, cystic fibrosis, bronchiectasis or neuromuscular disease.†If oximetry is not available, or reliable oxygen saturations cannot be determined and hypoxaemia is suspected, oxygen can be delivered at:

  1. ◦ 1–2 L/min via nasal cannulae or 2–4 L/min via 24% or 28% Venturi mask in patients with acute exacerbations of COPD or conditions known to be associated with chronic respiratory failure.*

  2. ◦ 2–4 L/min oxygen via nasal cannulae in patients who are not critically ill and life-threatening hypoxaemia is not suspected.

  3. ◦ 5–10 L/min via simple face mask, or 15 L/min through a 100% non-rebreather reservoir mask, or high flow nasal cannulae (FiO2 > 0.35) in patients who are critically ill or in whom life-threatening hypoxaemia is suspected (e.g. post-cardiac arrest or resuscitation, shock, sepsis, near drowning, anaphylaxis, major head injury or in suspected carbon monoxide poisoning). NIV or invasive ventilation and transfer to HDU or ICU should also be considered in this situation.

ABG, arterial blood gas; COPD, chronic obstructive pulmonary disease; HDU, high dependency unit; HFNC, high flow nasal cannulae; ICU, intensive care unit; MDI, metered dose inhaler; NIV, non-invasive ventilation; O2, oxygen; PaCO2, arterial partial pressure of carbon dioxide; PaO2, arterial partial pressure of oxygen; Sats, oxygen saturations; SpO2, oxygen saturation determined by pulse oximetry.

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