Updates and corrections to the Guideline
Flow rates from the reservoir mask: correct flow rate should be 15L/min.
Amendment to recommended flow rate from the reservoir mask: This should be be 15L/min in all situations.
To ensure an adequate gas flow for critically ill and hypoxaemic patients, the Guideline Development Group have recommended a standard flow rate of 15 l/min from reservoir masks in all circumstances where they are used. The manufacturer that previously recommended a flow of 10-15 l/min for reservoir masks has agreed with this advice and will amend the packaging accordingly.
The correct flow rate is given in Table 1 and Figure 2 (Chart 2 for devices).
The flow rate given in Table 2 for reservoir masks should be 15L/min.
The flow rate of 10-15 l/min mentioned in the following sections should read 15L/min:
8.9 introductory paragraph
8.9.1
8.10
8.10.2 (recommendation)
8.10.4
8.10.6
8.11.1
10.2.1
Page 62 first note under recommendation 29b
Appendix 1 (table 2)
Appendix 3 Section D on Reservoir Mask and Table 2
22/7/09
The Emergency Oxygen Alert Card is now available. This card can be printed, cut out and given to patients for them to keep in their wallet/purse.
Click here to download the version in English
Click here to download the version in Welsh
Section 10.2, page vi49 of the full guideline. The title of Table 11 has been amended to the following:
Table 11 Total gas flow rate (l/min) from selected Venturi masks at different oxygen flow-rates based on the following equation; Total flow = oxygen flow x (1 + ((1 - FiO2v)/(FiO2v - 0.2094)), where FiO2v is the FiO2 delivered by the Venturi device.
(The recommended oxygen flow rate and the delivered total gas flow rates of devices from some manufacturers may be slightly different from the figures shown in this Table. Some manufacturers of Venturi mask previously recommended a starting flow rate of 12 l/min of oxygen for the 60% Venturi device which gives a total gas flow rate of only 24 litres per minute. The Guideline Development Group recommends a flow rate of 15 litres per minute to give a total gas flow of 30 l/min in line with the recommendation of the majority of manufacturers). Please also note that the flow rate for the 40% oxygen mask at 15l/min has been corrected to 62 l/min.
The amended version of Table 11 is available here.
The amended version of Figure 11b is available here.
BTS 15/6/09
Please note the following amendments to Paragraphs 11.1.2 and 11.1.3 (page vi 56) of the guideline. We have been advised that there is not a legal requirement for oxygen to be given with the support of a Patient Group Direction (PGD) and so the text in the relevant paragraphs has been corrected as follows :
Paragraph 11.1.2, final sentence should now read:
"Each hospital should have an agreed policy and protocol for oxygen prescribing and administration to allow staff to adjust oxygen delivery devices and to give oxygen in emergency situations prior to the availability of a prescription."
Paragraph 11.1.3, final sentence should now read:
"Implementing this policy will require all hospitals to have agreed procedures and training programmes for all clinical staff and regular training programmes in the safe use of oxygen and audit of outcomes."
Appendix 3 has been amended to take these amendments into account.
These amendments have the support of the Royal Pharmaceutical Society of Great Britain.
BTS 20/2/09
Please note the following correction to Chart 1 which is printed correctly on this website but there is a minor error in the printed version in Thorax:
The fourth box down from the top on the right hand side of Chart 1 should state:
SpO2 <94% on air or oxygen
Or if requiring oxygen to achieve above targets
The following downloads available from this website all contain the correct version of Chart 1
Appendix 1
Chart 1
Executive Summary
Please note the following correction to Chart 2 - there is a minor error in the printed version in Thorax:
The nasal cannulae dose in the third step down on the right should read:
Nasal cannulae 4-6 l/min
The download of Chart 2 below shows this correction.
Addendum
The Guideline Development Group regret that no advice was offered for the management of status epilepticus. As this is a life-threatening condition where a patient may suffer from cerebral hypoxia (and oximetry may not be possible), patients with status epilepticus should be treated in accordance with Table 1 (reservoir mask until clinically stabilised). This advice also applies to other rare conditions which may cause life-threatening hypoxaemia that are not listed specifically in Table 1.
The above correction appears in Thorax (Thorax 2009;64:91) and is available online here.
27/10/08