From the Guidelines
Oxygen should be titrated to maintain an oxygen saturation (SpO2) of 94-98% for most adult patients requiring supplemental oxygen, as recommended by the British Thorax Society guideline 1. For patients with chronic obstructive pulmonary disease (COPD) or those at risk of hypercapnic respiratory failure, a lower target of 88-92% is suggested pending the availability of blood gas results 1. Key considerations for oxygen titration include:
- Starting with low-flow oxygen (1-2 L/min via nasal cannula) and adjusting in small increments every 5-10 minutes until the target saturation is reached
- Using higher flow rates or different delivery devices (simple face mask, non-rebreather mask, high-flow nasal cannula) for patients with more severe hypoxemia
- Continuously monitoring oxygen saturation, especially during the initial titration period
- Regularly reassessing oxygen saturation and adjusting flow rates to maintain appropriate oxygenation, as oxygen requirements may change with the patient's condition 1. It is also important to note that most non-hypoxaemic breathless patients do not benefit from oxygen therapy, and a sudden reduction of ≥3% in a patient’s oxygen saturation within the target saturation range should prompt fuller assessment of the patient and the oximeter signal 1.
From the Research
Oxygen Saturation Targets
- The target oxygen saturation range for oxygen therapy in adult patients without COPD or other conditions associated with chronic respiratory failure is 92-96% 2.
- This range is considered preferable to the 94-98% target range recommended by the British Thoracic Society 2.
- For patients with COPD who are experiencing acute respiratory distress, the use of supplemental oxygen should be titrated to maintain an oxygen saturation within a target range, although the exact range is not specified in the available evidence.
Titration of Oxygen
- Oxygen titration post-return-of-spontaneous-circulation (ROSC) is feasible in the prehospital environment, but incremental titration commencing at 4L/min oxygen flow may be needed to maintain an oxygen saturation >90% 3.
- The majority of patients who underwent oxygen titration had a SpO2 ≥ 94% on arrival at hospital, and all patients had a SpO2 ≥ 90% 3.
- There is no clear evidence to support a specific oxygen saturation target for titration in patients with acute hypoxemic respiratory failure, although maintaining a saturation above 90% is generally considered acceptable 3, 4.
Comparison of Oxygen Therapy Modalities
- High-flow nasal cannula oxygen therapy and non-invasive ventilation are comparable in preventing reintubation after extubation in COPD patients 5.
- High-flow nasal cannula oxygen therapy may produce improved tolerance, comfort, and less complications compared to non-invasive ventilation 5.
- The choice of oxygen therapy modality should be individualized based on patient characteristics and clinical judgment 5.