From the Guidelines
The target oxygen saturation level for inpatients should be maintained between 94-98% for acutely ill patients not at risk of hypercapnic respiratory failure, as recommended by the BTS guideline for oxygen use in adults in healthcare and emergency settings 1. When considering patients with specific conditions, the following targets are suggested:
- For patients with known chronic obstructive pulmonary disease (COPD) or other known risk factors for hypercapnic respiratory failure, a target saturation range of 88–92% is recommended pending the availability of blood gas results 1. Key points to consider in oxygen therapy include:
- Most non-hypoxaemic breathless patients do not benefit from oxygen therapy, but a sudden reduction of ≥3% in a patient’s oxygen saturation within the target saturation range should prompt fuller assessment of the patient 1.
- Oxygenation is reduced in the supine position, so fully conscious hypoxaemic patients should ideally be allowed to maintain the most upright posture possible unless there are good reasons to immobilise the patient 1. It is essential to titrate oxygen therapy to achieve these targets using the appropriate delivery device and flow rate, and continuous monitoring via pulse oximetry is crucial to maintain appropriate oxygen saturation levels and avoid potential complications such as tissue hypoxia, organ dysfunction, oxidative stress, and vasoconstriction.
From the Research
Target Oxygen Saturation Levels
The target oxygen saturation level in inpatients can vary depending on the patient's condition and the guidelines being followed.
- For adult patients without COPD or other conditions associated with chronic respiratory failure, a target oxygen saturation range of 92-96% is recommended by the Thoracic Society of Australia and New Zealand 2.
- The British Thoracic Society recommends a target oxygen saturation range of 94-98% for medically unwell adult patients, and 88-92% for patients at risk of hypercapnic respiratory failure 3.
- A literature review on hyperoxia in the management of respiratory failure suggests that the target oxygen saturation in all conditions is 94-98% 4.
- For ventilated patients and non-ventilated patients not at risk of hypercapnia, a target range of 92% and 96% for oxygen saturation is recommended 5.
- For patients with severe respiratory distress when SpO2 cannot be derived, high-dose O2 therapy without a target range may be indicated 5.
- A study on S(p)O(2) values in acute medical admissions breathing air suggests that the target saturation for actively treated patients not at risk of hypercapnic respiratory failure could be 96-98% 6.
Patient-Specific Target Ranges
- Patients at risk of hypercapnic respiratory failure, such as those with chronic obstructive pulmonary disease (COPD), may require a lower target oxygen saturation range of 88-92% 3, 5.
- Patients undergoing extracorporeal procedures should be monitored with arterial blood gases, and their target oxygen saturation range may vary depending on the specific procedure 5.
- Patients with acute hypercapnic respiratory failure may benefit from high-flow oxygen therapy (HFNC) with high flow rates, which is not inferior to noninvasive ventilation (NIV) 5.