By how many liters per minute (lit/min) should oxygen be decreased for a patient who has recovered from pneumonia?

Oxygen Weaning for Recovered Pneumonia Patients

For stable patients recovering from pneumonia on the ward, decrease oxygen by stepping down to 2 L/min via nasal cannulae before discontinuation, or to 1 L/min for patients at risk of hypercapnic respiratory failure. 1

Stepwise Weaning Algorithm

Initial Assessment Before Weaning

• Confirm the patient is clinically stable with oxygen saturation maintained in the target range (94-98% for most patients, or 88-92% if at risk for hypercapnic respiratory failure) 1, 2
• Verify saturation has been in the upper zone of the target range for 4-8 hours 1
• Check that respiratory rate, heart rate, blood pressure, and mental status are stable 2

Weaning Protocol

• Most stable convalescent patients: Step down gradually to 2 L/min via nasal cannulae as the final step prior to cessation of oxygen therapy 1
• Patients at risk of hypercapnic respiratory failure (e.g., COPD, severe obesity, neuromuscular disease): Step down to 1 L/min via nasal cannulae or occasionally 0.5 L/min, or use a 24% Venturi mask at 2 L/min as the lowest concentration before stopping oxygen 1
• Allow the new delivery system and flow rate to continue if target saturation is maintained; repeat blood gas measurements are not required if the patient remains stable 1

Discontinuation Process

• Stop oxygen therapy once the patient is clinically stable on low-concentration oxygen with saturation within the desired range on two consecutive observations 1, 2
• Monitor oxygen saturation on room air for 5 minutes after stopping oxygen therapy 1
• If saturation remains in the desired range, recheck at 1 hour 1
• If saturation and physiological track-and-trigger score (e.g., NEWS) are satisfactory at 1 hour, the patient has safely discontinued oxygen therapy 1

Critical Pitfalls to Avoid

If Desaturation Occurs During Weaning

• If saturation falls below the patient's target range when stopping oxygen, restart the lowest concentration that previously maintained the patient in the target range 1
• Monitor for 5 minutes to confirm this restores saturation into the target range 1
• If a patient requires oxygen to be restarted at a higher concentration than before to maintain the same target saturation, perform a clinical review to establish the cause for deterioration 1

Special Considerations

• Some patients may have episodic hypoxaemia during recovery (e.g., patients with COPD with intermittent mucus plugging) or may desaturate with mobilization despite being comfortable at rest 1
• The ongoing prescription of a target saturation range should remain active even after discontinuation to cover these occurrences 1
• Continue to monitor saturation and physiology on a regular basis according to the patient's underlying clinical condition even after successful discontinuation 1

Patients on Long-Term Oxygen Therapy

• Patients with chronic lung diseases already established on long-term oxygen therapy should be tapered slowly to their usual maintenance oxygen delivery device and flow rate 1
• For patients with COPD exacerbations, do not make decisions about long-term oxygen based on blood gas measurements made during acute exacerbations, as many will have improved PO2 at subsequent clinic visits 1