![]() ![]() Fully trained clinicians should assess all acutely ill patients by measuring pulse, blood pressure, respiratory rate and assessing circulating blood volume and anaemia. Ĭlinical and laboratory assessment of hypoxaemia and hypercapnia (section 7.1)ħ. īecause oxygenation is reduced in the supine position, fully conscious hypoxaemic patients should ideally be allowed to maintain the most upright posture possible (or the most comfortable posture for the patient) unless there are good reasons to immobilise the patient (eg, skeletal or spinal trauma). These patients should be treated as a high priority by emergency services and the oxygen dose should be reduced if the saturation exceeds 92%. For patients with prior hypercapnic failure (requiring non-invasive ventilation or intermittent positive pressure ventilation) who do not have an alert card, it is recommended that treatment should be commenced using a 28% Venturi mask at 4 l/min in prehospital care or a 24% Venturi mask at 2–4 l/min in hospital settings with an initial target saturation of 88–92% pending urgent blood gas results. In these cases it is recommended that treatment should be based on the results of previous blood gas estimations during acute exacerbations because hypercapnic respiratory failure can occur even if the saturation is below 88%. Some patients with COPD and other conditions are vulnerable to repeated episodes of hypercapnic respiratory failure. įor most patients with known chronic obstructive pulmonary disease (COPD) or other known risk factors for hypercapnic respiratory failure (eg, morbid obesity, chest wall deformities or neuromuscular disorders), a target saturation range of 88–92% is suggested pending the availability of blood gas results. Most non-hypoxaemic breathless patients do not benefit from oxygen therapy, but a sudden reduction of more than 3% in a patient’s oxygen saturation within the target saturation range should prompt fuller assessment of the patient (and the oximeter signal) because this may be the first evidence of an acute illness. Some normal subjects, especially people aged >70 years, may have oxygen saturation measurements below 94% and do not require oxygen therapy when clinically stable. The recommended target saturation range for acutely ill patients not at risk of hypercapnic respiratory failure is 94–98%. This guideline recommends aiming to achieve a normal or near-normal oxygen saturation for all acutely ill patients apart from those at risk of hypercapnic respiratory failure. SUMMARY OF KEY RECOMMENDATIONS FOR EMERGENCY OXYGEN USE Achieving desirable oxygen saturation ranges in acute illness (sections 6.7 and 6.8) Pulse oximetry must be available in all locations where emergency oxygen is used.Īll critically ill patients should be assessed and monitored using a recognised physiological track and trigger system. (The other vital signs are pulse, blood pressure, temperature and respiratory rate). Oxygen saturation, “the fifth vital sign”, should be checked by pulse oximetry in all breathless and acutely ill patients (supplemented by blood gases when necessary) and the inspired oxygen concentration should be recorded on the observation chart with the oximetry result. The guideline suggests aiming to achieve normal or near-normal oxygen saturation for all acutely ill patients apart from those at risk of hypercapnic respiratory failure or those receiving terminal palliative care.įor critically ill patients, high concentration oxygen should be administered immediately ( table 1 and fig 1) and this should be recorded afterwards in the patient’s health record. The essence of this guideline can be summarised simply as a requirement for oxygen to be prescribed according to a target saturation range and for those who administer oxygen therapy to monitor the patient and keep within the target saturation range. (Oxygen has not been shown to have any effect on the sensation of breathlessness in non-hypoxaemic patients.) Oxygen is a treatment for hypoxaemia, not breathlessness. EXECUTIVE SUMMARY OF THE GUIDELINE Philosophy of the guideline ![]()
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