BNF for Children 2011-2012

164 3.6 Oxygen BNFC 2011–20123 Respiratory system. severe kyphoscoliosis or severe ankylosingspondylitis;. severe lung scarring caused by tuberculosis;. musculoskeletal disorders with respiratory weakness,especially if on home ventilation;. an overdose of opioids, benzodiazepines, or otherdrugs causing respiratory depression.Until blood gases can be measured, initial oxygenshould be given using a controlled concentration of28% or less, titrated towards a target concentration of88–92%. The aim is to provide the child with enoughoxygen to achieve an acceptable arterial oxygen tensionwithout worsening carbon dioxide retention and respiratoryacidosis.Domiciliary oxygen Oxygen should only be prescribedfor use in the home after careful evaluation inhospital by a respiratory care specialist. Carers andchildren who smoke should be advised of the risks ofsmoking when receiving oxygen, including the risk offire. Smoking cessation therapy (section 4.10.2) shouldbe tried before home oxygen prescription.Long-term oxygen therapyThe aim of long-term oxygen therapy is to maintainoxygen saturation of at least 92%. Children (especiallythose with chronic neonatal lung disease) often requiresupplemental oxygen, either for 24-hours a day or duringperiods of sleep; many children are eventuallyweaned off long-term oxygen therapy as their conditionimproves.Long-term oxygen therapy should be considered forchildren with conditions such as:. bronchopulmonary dysplasia (chronic neonatallung disease);. congenital heart disease with pulmonary hypertension;. pulmonary hypertension secondary to pulmonarydisease;. idiopathic pulmonary hypertension;. sickle-cell disease with persistent nocturnal hypoxia;. interstitial lung disease and obliterative bronchiolitis;. cystic fibrosis;. obstructive sleep apnoea syndrome;. neuromuscular or skeletal disease requiring noninvasiveventilation;. pulmonary malignancy or other terminal diseasewith disabling dyspnoea.Increased respiratory depression is seldom a problem inchildren with stable respiratory failure treated with lowconcentrations of oxygen although it may occur duringexacerbations; children and their carers should bewarned to call for medical help if drowsiness or confusionoccurs.Short-burst oxygen therapyOxygen is occasionally prescribed for short-burst (intermittent)use for episodes of breathlessness.Ambulatory oxygen therapyAmbulatory oxygen is prescribed for children on longtermoxygen therapy who need to be away from homeon a regular basis.Oxygen therapy equipmentUnder the NHS oxygen may be supplied as oxygencylinders. Oxygen flow can be adjusted by means of anoxygen flow meter. Oxygen delivered from a cylindershould be passed through a humidifier if used for longperiods.Oxygen concentrators are more economical for childrenwho require oxygen for long periods, and in Englandand Wales can be ordered on the NHS on a regionaltendering basis (see below). A concentrator is recommendedfor a child who requires oxygen for more than 8hours a day (or 21 cylinders per month). Exceptionally, ifa higher concentration of oxygen is required the outputof 2 oxygen concentrators can be combined using a ‘Y’connection.A nasal cannula is usually preferred to a face mask forlong-term oxygen therapy from an oxygen concentrator.Nasal cannulas can, however, cause dermatitis andmucosal drying in sensitive individuals.Giving oxygen by nasal cannula allows the child to talk,eat, and drink, but the concentration is not controlledand the method may not be appropriate for acute respiratoryfailure. When oxygen is given through a nasalcannula at a rate of 1–2 litres/minute the inspiratoryoxygen concentration is usually low, but it varies withventilation and can be high if the child is underventilating.Arrangements for supplying oxygenThe following services may be ordered in England andWales:. emergency oxygen;. short-burst (intermittent) oxygen therapy;. long-term oxygen therapy;. ambulatory oxygen.The type of oxygen service (or combination of services)should be ordered on a Home Oxygen Order Form(HOOF); the amount of oxygen required (hours perday) and flow rate should be specified. The supplierwill determine the appropriate equipment to be provided.Special needs or preferences should be specifiedon the HOOF.The clinician should obtain the patient’s consent to passon the patient’s details to the supplier and the firebrigade. The supplier will contact the patient to makearrangements for delivery, installation, and maintenanceof the equipment. The supplier will also train the patientto use the equipment.The clinician should send order forms to the supplier byfacsimile (see below); a copy of the HOOF should besent to the Primary Care Trust or Local Health Board.The supplier will continue to provide the service until arevised order is received, or until notified that thepatient no longer requires the home oxygen service.