New Guidance Recommends Minimal Oxygen for Most Inpatients

Jennifer Garcia

October 24, 2018

Supplemental oxygen is not always indicated for acutely ill patients and may contribute to mortality, according to new recommendations published online October 24 in the BMJ.

As part of the "Rapid Recommendations" initiative of the BMJ, a panel of experts — including specialists, a nurse, a surgeon, a respiratory therapist, and patients — evaluated a recent systematic review and meta-analysis and developed recommendations regarding supplemental oxygen therapy.

The recommendations are aimed at treating critically ill patients, surgical patients with sepsis, hospitalized patients, or those en route to hospital in an ambulance. Postoperative, obstetric, and pediatric patients were not included in the review.

Key recommendations include:

  • Maintaining peripheral capillary oxygen saturation (SpO2) at or below 96% for patients receiving supplemental oxygen therapy

  • For patients with acute myocardial infarction or stroke, oxygen should not be administered if the initial SpO2 is ≥ 92%

    • Based on the available evidence, the panel made a weak recommendation against initiating oxygen therapy in those patients with an SpO2 between 90% and 92%

The panelists point out, however, that thresholds for SpO2 should be lower for patients at risk for hypercapnic respiratory failure.

The systematic review, which included 25 randomized controlled trials, also showed increases in mortality when SpO2 was above 96%; however, the panelists note that the reasons for the association are unclear.

Overall, the recommendation authors, led by Reed A. C. Siemieniuk, MD, PhD, from the Department of Health Research Methods, Evidence, and Impact, McMaster University, in Hamilton, Canada, suggest that "[a] target SpO2 range of 90-94% seems wide enough to allow for normal fluctuation, and is likely low enough to avoid harm." Further, they suggest that this range is wide enough that it does not require excessive attention and therefore result in an increase in healthcare costs.

The panelists have disclosed no relevant financial relationships.

BMJ. Published online October 24, 2018. Abstract

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