Policy for the Prescription, Administration and Monitoring Of Oxygen ...

Table 4. Conditions for which patients should be monitored closely butoxygen therapy is not required unless the patient is hypoxaemic‣ If hypoxaemic, the initial oxygen therapy is nasal cannulae at 2–6 l/min or simple facemask at 5–10 l/min unless saturation is ,85% (use reservoir mask) or if at risk fromhypercapnia (see below).‣ The recommended initial target saturation range, unless stated otherwise, is 94–98%.‣ If oximetry is not available, give oxygen as above until oximetry or blood gas results areavailable.‣ If patients have COPD or other risk factors for hypercapnic respiratory failure, aim at asaturation of 88–92% pending blood gas results but adjust to 94–98% if the PaCO2 isnormal (unless there is a history of respiratory failure requiring NIV or IPPV) and recheckblood gases after 30–60 min.Condition Additional comments Grade ofrecommendationMyocardial infarction andacutecoronary syndromesMost patients with acute coronaryartery syndromes are nothypoxaemic and the benefits/harmsof oxygen therapy are unknown insuch casesGrade DStroke Most stroke patients are nothypoxaemic. Oxygen therapy maybe harmful for non-hypoxaemicpatients with mild to moderatestrokesPregnancy and obstetricemergenciesOxygen therapy may be harmful tothe foetus if the mother is nothypoxaemicGrade BGrades A–DHyperventilation ordysfunctionalbreathingExclude organic illness. Patientswith pure hyperventilation due toanxiety or panic attacks are unlikelyto require oxygen therapy.Rebreathing from a paper bag maycause hypoxaemia and is notrecommendedGrade CMost poisonings and drugoverdoses (see table 1 forcarbon monoxidepoisoning)Hypoxaemia is more likely withrespiratory depressant drugs, giveantidote if available (e.g. naloxonefor opiate poisoning).Check blood gases to excludehypercapnia if a respiratorydepressantdrug has been taken. Avoid highblood oxygen levels in cases ofPolicy for the prescription, administrationand monitoring of emergency oxygen in adultsPage 20 of 34Grade D