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June 2017 Volume 72 Supplement 1 72 S1 Volume 72 Supplement 1 Pages i1–i90 ThoraxAN INTERNATIONAL JOURNAL OF RESPIRATORY MEDICINE BTS GUIDELINE FOR OXYGEN USE THORAX IN ADULTS IN HEALTHCARE AND EMERGENCY SETTINGS British Thoracic Society Emergency Oxygen Guideline Development Group June 2017 thorax.bmj.com thoraxjnl_72_S1_Cover.indd 1 10/05/17 5:31 PM Endorsements Healthcare providers need to use clinical judgement, knowledge and expertise when deciding whether it is appropriate to apply recommendations for the management of patients. The recommendations cited here are a guide and may not be appropriate for use in all situations. The guidance provided does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer. thoraxjnl_72_S2_Title_Page.indd 2 11/05/17 6:51 PM BTS Emergency Oxygen Guideline Development Group B Ronan O’Driscoll, Luke Howard, John Earis, Vince Mak, Sabrina Bajwah, Richard Beasley, Katrina Curtis, Anthony Davison, Alistair Dorward, Chris Dyer, Angela Evans, Lucy Falconer, Clare Fitzpatrick, Simon Gibbs, Kim Hinshaw, Robin Howard, Binita Kane, Jeff Keep, Carol Kelly, Hasanin Khachi, Muhammed Asad Iqbal Khan, Roop Kishen, Leigh Mansfi eld, Bruce Martin, Fionna Moore, Duncan Powrie, Louise Restrick, Christine Roffe, Mervyn Singer, Jasmeet Soar, Iain Small, Lisa Ward, David Whitmore, Wisia Wedzicha, Meme Wijesinghe British Thoracic Society Emergency Oxygen Guideline Development Group On behalf of the British Thoracic Society The BTS Guideline for oxygen use in adults in healthcare and emergency settings has been endorsed by: Association of British Neurologists Association of Chartered Physiotherapists in Respiratory Care Association for Palliative Medicine Association of Respiratory Nurse Specialists Association for Respiratory Technology and Physiology British Association of Stroke Physicians British Geriatrics Society College of Paramedics Intensive Care Society Joint Royal Colleges Ambulance Liaison Committee Primary Care Respiratory Society UK Resuscitation Council (UK) Royal College of Anaesthetists The Royal College of Emergency Medicine Royal College of General Practitioners Royal College of Nursing (endorsement granted until April 2020) Royal College of Obstetricians and Gynaecologists Royal College of Physicians Royal College of Physicians of Edinburgh Royal College of Physicians and Surgeons of Glasgow Royal Pharmaceutical Society The Society for Acute Medicine thoraxjnl_72_S2_Title_Page.indd 1 11/05/17 6:51 PM Contents Volume 72 Supplement 1 | THORAX June 2017 Abbreviations and symbols used in this i19 3.2 Defi nitions of hypoxaemia, hypoxia, type 1 guideline respiratory failure and hyperoxaemia i19 3.3 Defi nition of hypercapnia and type 2 Executive summary respiratory failure i19 3.4 Defi nition of acidosis (respiratory acidosis Summary of recommendations and metabolic acidosis) Journal of the British Thoracic Society i2 Table 1 Critical illness requiring high levels of i17 Table 8 Mean (SD) PaO2 (kPa and mmHg) and Impact Factor: 8.121 supplemental oxygen SaO (%) values (with range) Editors-in-Chief i4 Table 2 Serious illnesses requiring moderate 2 N Hart (UK) i17 Table 9 Ranges, mean, SD, median and IQR G Jenkins (UK) level of supplemental oxygen if the patient is values for SpO (%) where measurements AR Smyth (UK) 2 hypoxaemic were made with the patient receiving air for Deputy Editors i4 Table 3 Conditions for which patients should N Kaminski (USA) age ≥18 years (n=37 299) from Smith et al M Rosenfeld (USA) be monitored closely but oxygen therapy is not Associate Editors required unless the patient is hypoxaemic Section 4: General blood gas physiology D Baldwin (UK) J-L Pepin (France) R Chambers (UK) M Polkey (UK) i5 Table 4 COPD and other conditions requiring i20 4.1 Oxygen physiology T Coleman (UK) J Quint (UK) GJ Criner (USA) N Rahman (UK) controlled or low-dose oxygen therapy i20 4.2 Carbon dioxide physiology J Davies (UK) K Robinson (USA) i11 Table 5 Abbreviations for oxygen devices for A Floto (UK) S Shaheen (UK) i21 4.3 Concept of target oxygen saturation (SaO2) M Griffi ths (UK) R Stevens (USA) use on bedside charts. ranges L Heaney (UK) A Vonk Noordegraaf N Hopkinson (UK) (The Netherlands) i3 Figure 1 Chart 1—oxygen prescription S Janes (UK) C Wainwright (Australia) guidance for acutely hypoxaemic patients in Section 5: Advanced blood gas physiology B Kampman (UK) T Wilkinson (UK) i21 5.1 Oxygen delivery B Mohkelesi (USA) P Wolters (USA) hospital P O’Byrne (Canada) i6 Figure 2 Chart 2—fl ow chart for oxygen i22 5.1.1 Arterial oxygen tension i23 5.1.2 Haematocrit Statistical Editors administration on general wards in hospitals A Douiri (UK) i23 5.1.3 The oxyhameoglobin dissociation curve C Flach (UK) C Jackson (UK) Section 1: Introduction and the Bohr effect S Stanojevic (USA) i14 1.1 Aim of the guideline i23 5.1.4 Regulation of DO2 R Szczesniak (USA) B Wagner (USA) i14 1.2 Intended users of the guideline and target i23 5.2 Pathophysiology of hypoxia and hyperoxia Y Wang (UK) patient populations i23 5.2.1 Hypoxaemic hypoxia Journal Club Editor i14 1.3 Areas covered by the guideline i24 5.2.2 Other mechanisms of hypoxia J Quint (UK) i24 5.2.3 Hyperoxia President, British Thoracic Society i14 1.4 Areas not covered by the guideline E Chilvers i14 1.5 Key changes since the 2008 guideline i24 5.3 Physiology of carbon dioxide Editorial Offi ce i15 1.6 Limitations of the guideline i24 5.3.1 Normal carbon dioxide homoeostasis Thorax, BMA House, Tavistock Square, London WC1H 9JR, UK i24 5.3.2 Regulation of carbon dioxide T: +44 (0)20 7383 6373 Section 2: Methodology of guideline i24 5.4 Pathophysiology of hypercapnia and E: [email protected] production hypocapnia Twitter: @ThoraxBMJ i15 2.1 Establishment of guideline team i24 5.4.1 Mechanisms of hypercapnia ISSN: 0040-6376 (print) ISSN: 1468-3296 (online) i15 2.2 Summary of key questions i25 5.4.2 Hypoventilation and hyperventilation Disclaimer: Thorax is owned and published by the i16 2.3 How the evidence was assimilated into the i25 5.5 Physiology of oxygen therapy British Thoracic Society and BMJ Publishing Group Ltd, a wholly owned subsidiary of the British Medical guideline i25 5.6 Strategies for improving oxygenation and Association. The owners grant editorial freedom to delivery the Editor of Thorax. i16 2.4 Piloting, implementing and auditing the Thorax follows guidelines on editorial independence guideline produced by the World Association of Medical Editors and the code on good publication practice i17 2.5 Planned review and updating of the MORE CONTENTS ᭤ of the Committee on Publication Ethics. guideline Thorax is intended for medical professionals and is provided without warranty, express or implied. i17 2.6 Declarations of interest Statements in the Journal are there sponsibility of their authors and advertisers and not authors’ i15 Table 6 SIGN levels of evidence institutions, the BMJ Publishing Group Ltd, the This article has been chosen by the Editors to be of special interest British Thoracic Society or theBMAunless otherwise i15 Table 7 SIGN grades of recommendation specifi ed or determined by law. Acceptance of or importance and is freely available online. advertising does not imply endorsement. To the fullest extent permitted by law, the BMJ Section 3: Normal values and defi nitions This article has been made freely available online under the BMJ Publishing Group Ltd shall not be liable for any loss, Journals Open Access scheme. injury or damage resulting from the use of Thorax i17 3.1 Blood gas levels of oxygen and carbon OPEN ACCESS or any information in it whether based on contract, See http://journals.bmj.com/site/authors/openaccess.xhtml tort or otherwise. Readers are advised to verify any dioxide in health and disease information they choose to rely on. i17 3.1.1 Normal ranges for oxygen saturation This journal is a member of and subscribes to the principles of the Copyright: © 2017 BMJ Publishing Group Ltd and the British Thoracic Society. All rights reserved; no (SaO2 and SpO2) and PO2 (PaO2) in the blood at Committee on Publication Ethics part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or sea level http://publicationethics.org/ by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission i17 3.1.2 Oxygen saturation in older adults of Thorax. i18 3.1.3 Oxygen saturation at altitude Thorax is published by BMJ Publishing Group Ltd, typeset by Nova Techset Private Limited, Bengaluru i18 3.1.4 Oxygen saturation in acute and chronic & Chennai, India and printed in the UK on acid-free paper. diseases Thorax (ISSN No: 0040–6376) is published i18 3.1.5 Variation in oxygen saturation during sleep monthly by BMJ Publishing Group and distributed in the USA by Air Business Ltd. Periodicals postage i19 3.1.6 Normal range for arterial carbon dioxide paid at Jamaica NY 11431. POSTMASTER: send address changes to Thorax, Air Business Ltd, c/o tension Worldnet Shipping Inc., 156-15, 146th Avenue, 2nd Floor, Jamaica, NY 11434, USA.s thoraxjnl_72_S1_TOC.indd 1 11/05/17 6:56 PM Contents Volume 72 Supplement 1 | THORAX June 2017 i25 5.6.1 Optimising PaO2 Section 7: Clinical and laboratory i26 5.6.2 Optimising oxygen carriage assessment of hypoxaemia and i26 5.6.3 Optimising delivery hypercapnia i22 Figure 3 Regulation of CaO 2 i33 7.1 Assessment of hypoxaemia i22 Figure 4 Ventilatory response to hypoxaemia i33 7.1.1 Clinical
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