Attitudes to oxygen administration are changing as new research is conducted calling into question the safety of oxygen in patients who are not hypoxic. Accordingly many organisations are reviewing their recommendations as to the use of oxygen and a number of guidelines in this regard have been published.
The Australian Resuscitation Council has reviewed oxygen administration at a number of levels. At a first responder/first aid level the current ARC Guideline 10.4 remains appropriate with no significant change required.
At an ALS level the role of oxygen in acute coronary syndrome (ACS) has already been addressed. The ACS Guideline states; “Supplemental oxygen should be initiated if the patient has breathlessness, hypoxaemia, signs of heart failure or shock. There is relatively limited evidence from clinical studies to support the routine use of oxygen therapy in ACS. The use of oxygen saturation monitoring by non-invasive techniques such as pulse oximetry, may be very useful in guiding oxygen therapy. However it is important to understand that hyperoxaemia may be potentially harmful in uncomplicated myocardial infarction”.
Whether the cautions about hyperoxaemia will prove to be applicable to all patients or just in specific patient groups such as ACS and possibly stroke remains to be demonstrated. In addition, there is a lack of consistency as to what value or range of values of oxygen saturation constitutes hypoxaemia.
The Australian Resuscitation Council clearly recommends that hypoxaemia should be avoided. However at this time there is insufficient evidence to clearly state a range of target oxygen saturation or enough clarity to recommend which patient groups the use of titrated oxygen should apply. The ARC will continue to monitor the research and revise its guidelines where the evidence becomes available to support recommendations on targeted oxygen therapy.
In relation to newborn infants, for specific guidelines about use of oxygen and for recommended target saturations, please see Guideline 13.4, Airway Management and Mask Ventilation of the Newborn Infant, pages 10-11.
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