When can SpO2 (Peripheral Capillary Oxygen Saturation) therapy be safely discontinued?

Steps to Safely Discontinue Oxygen Therapy

Oxygen therapy should be stopped once a patient is clinically stable on low-concentration oxygen (typically 2 L/min via nasal cannulae, or 1 L/min for those at risk of hypercapnic respiratory failure) and the oxygen saturation is within the desired range on two consecutive observations. 1

Gradual Weaning Process

Step Down Protocol for Most Patients

• Reduce oxygen concentration gradually when the patient is clinically stable and oxygen saturation is above the target range or has been in the upper zone of the target range for 4-8 hours 1
• Most stable convalescent patients should be stepped down to 2 L/min via nasal cannulae as the final step before cessation 1
• Patients at risk of hypercapnic respiratory failure (COPD, morbid obesity, neuromuscular disorders) may be stepped down to 1 L/min or occasionally 0.5 L/min via nasal cannulae, or a 24% Venturi mask at 2 L/min as the lowest concentration 1

When to Stop Oxygen

• Discontinue oxygen when the patient is clinically stable on low-concentration oxygen AND oxygen saturation is within the desired range (94-98% for most patients, 88-92% for those at risk of hypercapnia) on two consecutive observations 1
• Repeat blood gas measurements are NOT required for stable patients who require reduced oxygen concentration or cessation of oxygen therapy 1

Post-Discontinuation Monitoring Protocol

Immediate Monitoring (First 5 Minutes)

• Monitor oxygen saturation on room air for 5 minutes after stopping oxygen therapy 1
• If saturation remains in the desired range during this period, proceed to the next monitoring step 1

One-Hour Recheck

• Recheck oxygen saturation at 1 hour after discontinuation 1
• If the oxygen saturation and physiological track-and-trigger score (e.g., NEWS) is satisfactory at 1 hour, the patient has safely discontinued oxygen therapy 1
• Continue regular monitoring of saturation and physiology according to the patient's underlying clinical condition even after successful discontinuation 1

Management of Failed Discontinuation

If Saturation Falls Below Target

• Restart oxygen at 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 successful, continue oxygen therapy at this level and attempt discontinuation again at a later date provided the patient remains clinically stable 1

If Higher Oxygen Concentration Required

• Arrange clinical review to establish the cause for deterioration if a patient requires oxygen therapy to be restarted at a higher concentration than before to maintain the same target saturation range 1

Important Considerations

Maintain Active Prescription

• Keep the prescription for a target saturation range active even after successful discontinuation in case of future deterioration 1
• This allows for oxygen administration if episodic hypoxaemia occurs (e.g., after minor exertion or due to mucus plugging) 1

Transient Desaturation

• Transient asymptomatic desaturation does not require correction - some patients may have episodic hypoxaemia after safely discontinuing oxygen therapy 1

Common Pitfalls to Avoid

• Abrupt discontinuation without gradual weaning can lead to rebound hypoxemia 2
• Inappropriate target ranges - using standard targets (94-98%) for patients at risk of hypercapnic respiratory failure instead of 88-92% can cause harm 2
• Premature discontinuation - stopping oxygen before achieving stability on low-concentration oxygen with two consecutive satisfactory observations 1
• Inadequate post-discontinuation monitoring - failing to monitor at 5 minutes and 1 hour after stopping oxygen 1