Although oxygen use has been a staple in medical practice for decades, new recommendations suggest limited use in certain patient populations, according to a new Rapid Recommendation published by the BMJ.
“A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital,” the authors wrote.
Published as part of the BMJ’s “Rapid Recommendations” series, the new recommendations were created by a panel of international experts using the GRADE framework.
The research questions asked during creation of these recommendations were:
• In acutely ill patients, when should oxygen therapy be started? (What is the lower limit of SpO2?)
• In acutely ill patients receiving oxygen therapy, how much oxygen should be given? (What is the upper limit of SpO2?)
The 3 main recommendations include:
1. Acutely ill adult medical patients (with exceptions) should stop oxygen therapy no higher than 96% saturation. (strong recommendation)
2. Patients with acute stroke or MI should not start oxygen therapy between 90% and 92% saturation. (weak recommendation)
3. Patients with acute stroke or MI should not start oxygen therapy at or above 93% saturation. (strong recommendation)
“The ideal oxygen saturation at which to start oxygen therapy is uncertain, but is likely below 93%,” the authors wrote.
The panel did not make a recommendation for when to start (the lower limit) oxygen for all medical patients, because there was not enough evidence.
Siemieniuk RAC, Chu DK, L HY Kim, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169. https://doi.org/10.1136/bmj.k4169.