According to the new guidance, oxygen therapy is often unnecessary and can cause harm therefore minimal oxygen use for most patients is recommended.
A panel of international experts has opined that routine oxygen therapy is not recommended for hospital patients because the benefit is uncertain and there are clear harms. The recommendations have appeared in The BMJ today. The BMJ’ has put forward ‘Rapid Recommendations’ initiative in order to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.
At present oxygen therapy is extensively used in hospitals more so in sick patients and usually no attention paid to when to start and stop it. The present guidelines also vary on when to give oxygen, how much to give and when to stop it.
The levels of oxygen are measured by its blood saturation (SpO2) which in fact is the amount of haemoglobin in the bloodstream that is saturated with oxygen to carry it through the body. By and large, the normal oxygen saturation is between 96% and 98%, but sick patients are often kept close to 100%.
An international panel comprising of specialist doctors, a nurse, a surgeon, and patients discussed this latest evidence and formulated a recommendation-Giving extra oxygen to hospital patients with normal oxygen levels increases mortality. The evidence review published in The Lancet concluded that oxygen should be given conservatively, but they did not make specific recommendations on how to do it.
Key Recommendations include-
- Using the GRADE approach they made a strong recommendation to stop oxygen therapy in patients with a saturation of 96% or higher.
- For patients who have had a heart attack or stroke, they suggest not starting oxygen therapy when levels are between 90% and 92% saturation, and they strongly recommend not starting oxygen therapy when levels are at or above 93% saturation.
- There was not enough evidence to say exactly when oxygen should be started for many other medical conditions such as infections.
- For most patients, they say a target of 90-94% saturation seems reasonable and is low enough to avoid harm. In all cases, they advise using the minimum amount of oxygen necessary.
The authors point out that while their recommendations apply to most patients, they do not apply to surgical patients, babies, or patients with a few other uncommon conditions. And they say their recommendations may be altered as new evidence emerges.
Dr. Kamal Kant Kohli
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