When is oxygen therapy indicated

Double Your Gift. Your tax-deductible donation funds lung disease and lung cancer research, new treatments, lung health education, and more. Join over , people who receive the latest news about lung health, including COVID, research, air quality, inspiring stories and resources. Thank you! You will now receive email updates from the American Lung Association. Select your location to view local American Lung Association events and news near you. Our service is free and we are here to help you.

Oxygen Therapy. You are viewing BNF. Oxygen should be regarded as a drug. It is prescribed for hypoxaemic patients to increase alveolar oxygen tension and decrease the work of breathing. The concentration of oxygen required depends on the condition being treated; the administration of an inappropriate concentration of oxygen can have serious or even fatal consequences.

Oxygen is probably the most common drug used in medical emergencies. However, in some clinical situations such as cardiac arrest and carbon monoxide poisoning it is more appropriate to aim for the highest possible oxygen saturation until the patient is stable. High concentration oxygen therapy is safe in uncomplicated cases of conditions such as pneumonia, pulmonary thromboembolism, pulmonary fibrosis, shock, severe trauma, sepsis, or anaphylaxis.

In such conditions low arterial oxygen P a O 2 is usually associated with low or normal arterial carbon dioxide P a CO 2 , and therefore there is little risk of hypoventilation and carbon dioxide retention.

In acute severe asthma, the arterial carbon dioxide P a CO 2 is usually subnormal but as asthma deteriorates it may rise steeply particularly in children. These patients usually require high concentrations of oxygen and if the arterial carbon dioxide P a CO 2 remains high despite other treatment, intermittent positive-pressure ventilation needs to be considered urgently.

Low concentration oxygen therapy controlled oxygen therapy is reserved for patients at risk of hypercapnic respiratory failure, which is more likely in those with:. The aim is to provide the patient with enough oxygen to achieve an acceptable arterial oxygen tension without worsening carbon dioxide retention and respiratory acidosis.

Patients and their carers should be instructed to show the card to emergency healthcare providers in the event of an exacerbation. The oxygen alert card template is available at www.

Oxygen should only be prescribed for use in the home after careful evaluation in hospital by respiratory experts. Patients should be advised of the risks of continuing to smoke when receiving oxygen therapy, including the risk of fire.

For nasal prong oxygen without humidification a maximum flow of:. With the above flow rates humidification is not usually required. However, if humidification is clinically indicated - set up as per the recommended guidelines for the specific equipment used. As with the other delivery systems the inspired FiO2 depends on the flow rate of oxygen and varies according to the patient's minute ventilation.

If the required flow rate exceeds those as recommended above this may result in nasal discomfort and irritation of the mucous membranes. Therefore, humidification of nasal prong oxygen therapy is recommended. For nasal prong oxygen with humidification a maximum flow of:. Optiflow nasal prongs are compatible for use in humidified low or high flow oxygen delivery. See guide below for recommended patient sizing and flow rates. Fisher and Paykel Optiflow nasal cannula junior range Four sizes of prongs:.

See Appendix A for further information regarding appropriate junior range sizing: Fisher and Paykel Optiflow junior range sizing guide. RT circuit - click here for instructions for use.

This valve has been designed to minimize the risk of excessive pressure being delivered to the infant in the event that the nasal prongs seal around the infant's nares while the mouth is closed. The image below is of the RT circuit. RT Circuit and O2 stem - click here for instructions for use. High Flow in approved areas only. Optiflow Nasal Prong junior and standard humidification and flow rate guide for Airvo. At RCH both simple face masks in various sizes and tracheostomy masks are available.

The minimum flow rate through any face mask or tracheostomy mask is 4 LPM as this prevents the possibility of CO 2 accumulation and CO 2 re-breathing. Select a mask which best fits from the child's bridge of nose to the cleft of jaw, and adjust the nose clip and head strap to secure in place. Oxygen via intact upper airway via a simple face mask at flow rates of 4LPM does not routinely require humidification.

Additionally in some conditions eg. Asthma , the inhalation of dry gases can compound bronchoconstriction. A non-rebreathing face mask has an oxygen reservoir bag and one-way valve system which prevents exhaled gases mixing with fresh gas flow. The non-rebreathing mask system may also have a valve on the side ports of the mask which prevents entrainment of room air into the mask.

While a specific FiO 2 is delivered to the patient the FiO 2 that is actually inspired by the patient ie what the patient actually receives varies depending on:. At the RCH, oxygen therapy via an isolette is usually only for use in the Butterfly neonatal intensive care unit. See Isolette use in paediatric wards , RCH internal link only.

Appendix A - Pediatric sizing guides for nasal prongs. Fisher and Paykel Optiflow junior range sizing guide. The evidence table for this guideline can be viewed here. Please remember to read the disclaimer. Updated July The Royal Children's Hospital Melbourne.

Oxygen delivery. Oxygen delivery Aim Introduction Definition of terms Normal values and SpO 2 targets Indications for oxygen delivery Nurse initiated oxygen Patient assessment and documentation Weaning oxygen Selecting the delivery method Low flow delivery method High flow delivery method Considerations Links Appendix A - Paediatric sizing guides for nasal prongs Evidence Table References Aim The aim of this guideline is to describe the indications and procedure for the use of oxygen therapy, and its modes of delivery.

Give oxygen therapy in a way which prevents excessive CO 2 accumulation - i. Reduce the work of breathing. Ensure adequate clearance of secretions and limit the adverse events of hypothermia and insensible water loss by use of optimal humidification dependent on mode of oxygen delivery. Maintain efficient and economical use of oxygen. It is used to assess the adequacy of ventilation.

PaO 2 : The partial pressure of oxygen in arterial blood. It is used to assess the adequacy of oxygenation. SaO 2 : Arterial oxygen saturation measured from blood specimen. During sleep, breathing naturally slows down because the body doesn't need as much oxygen. Sleep-related breathing disorders are quite common in people with COPD, and many will have significantly low blood oxygen levels during sleep.

For air travel. The level of oxygen in airplanes is about the same as the oxygen level at an elevation of m ft. This drop in oxygen can really affect people with COPD. If you normally use oxygen or have borderline-low oxygen levels in your blood, you may need oxygen when you fly. Travelling with oxygen usually is possible.

But it is important to plan ahead before you travel. How Well It Works Several studies show that using oxygen at home for more than 15 hours a day increases quality of life and helps people live longer when they have severe COPD and low blood levels of oxygen. Risks Typically there are no risks from oxygen treatment as long as you follow your doctor's instructions.

What To Think About People using oxygen should not smoke. COPD, search date April McIvor RA, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.

Accessed November 27, A randomized trial of long-term oxygen for COPD with moderate desaturation.