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First guidance on emergency oxygen

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Anne Riches looks at the new British Thoracic Society’s recommendations for this therapy

The use of emergency oxygen therapy, indeed oxygen therapy per se, remains an enigma in the majority of healthcare settings.
The administration of oxygen therapy is often a learnt behaviour, based not on evidence but on custom and practice where the individual practitioner is employed.

Uncertainty and confusion about how much oxygen to give can result in its inappropriate use for breathlessness. Conversely, patients with extreme hypoxaemia (low blood oxygen level) can be left without oxygen as practitioners fear inducing carbon dioxide retention.

The new British Thoracic Society Guideline for Emergency Oxygen Use in Adults is therefore a welcome addition to the
clinical arena.

This document is endorsed by all the relevant professional societies and practitioner groups. It makes recommendations ranging from the type of oxygen mask to be used to how oxygen services should be established.

It comes with a shorter summary containing key recommendations, and this is more user-friendly. Practitioners should consult the document selectively depending on the area in which they work, their interests and knowledge base.

The guideline is absolutely clear that emergency oxygen is given for the treatment of all acutely ill patients so that oxygen saturation levels are maintained at a normal level, and not for breathlessness.

The guideline recommends that oxygen is prescribed and titrated to a target saturation range of 94–98% unless the patient is at risk of hypercapnic (high level of carbon dioxide) respiratory failure. It recommends lower target saturations of 88–92% for these patients.

The significance of pulse oximetry, which is deemed to be the ‘fifth vital sign’, is emphasised. The guideline adds that pulse oximeters should be available in all locations where emergency oxygen is used, and emphasises the importance of assessment and monitoring of acutely ill patients requiring oxygen.

There is also advice regarding patient preparation before arterial blood gases are taken, advocating the use of local anaesthesia ‘except in emergency situations’. This appears incongruous, as the guideline specifically considers the emergency use of oxygen.

The use of arterialised earlobe blood gases is discussed and the authors suggest there is a place for this intervention.

The proposal for widespread use of a specific oxygen alert card for patients who are at risk of carbon dioxide retention when given oxygen therapy is welcomed by all in the respiratory field.

While the guideline suggests emergency oxygen should be given first then documented later, it recognises the importance of prescribing oxygen.

The suggested flow chart could be used by all healthcare professionals for the practical application of oxygen therapy and be incorporated into oxygen prescription documentation.

The BTS has suggested the use of oxygen champions and many trusts have already nominated staff who will be instrumental
in implementing the recommendations.

The guideline is supported by a number of appendices that are available online. There is a useful PowerPoint presentation for nurses, which could be used to standardise education and training in most trusts.

There is potential for all healthcare professionals involved with delivering oxygen therapy in an emergency situation to influence practice through implementation of the guidelines. Hopefully this will lead to safer care for all patients.

Anne Riches, MA, BSc, RGN, is lead respiratory nurse specialist Countess of Chester NHS Foundation Trust, and senior lecturer, Respiratory Education UK


O’Driscoll, B.R. et al (2008) Guideline for emergency oxygen use in adults patients. Thorax; 63: Suppl 6, vi1–68.
The full guideline, summary and appendices can be downloaded:




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