BTS Guideline for oxygen use in healthcare and emergency settings

The 2017 guidance is based on new evidence about how effective prescribing and delivery of emergency oxygen for patients can improve health and saved lives. 

December 2019 Update

The BTS Standards of Care Committee has recently considered whether the publication of the new evidence in the form of a systematic review and meta-analysis¹ provides grounds for an update to certain recommendations within the BTS Guideline for oxygen use in healthcare and emergency settings².

The current recommendations state that the recommended target saturation range for acutely ill patients not at risk of hypercapnic respiratory failure is 94–98% and for those with known COPD, or other known risk factors for hypercapnic respiratory failure, a target saturation range of 88–92% is suggested, pending the availability of blood gas results. In response to the conclusions drawn from the systematic review and meta-analysis on mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA)¹, the BTS Standards of Care Committee notes that the major thrust of the guideline was to mandate the use of controlled vs liberal oxygen therapy; thus, the overall messages from the BTS guideline² and the systematic review¹ are aligned in stating that controlling oxygen to a target saturation is paramount. The IOTA meta-analysis showed higher oxygen saturations were associated with higher mortality, but the optimal target range was not clearly defined.  An interim update of the BTS guideline is not required at the present time.

1. Chu DK et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet (2018) 391(10131):1693-1705

2. O'Driscoll BR et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax (2017) 72(Suppl 1):ii1-ii90

December 2019