Is high-flow oxygen therapy (HiFO) routinely administered to patients in physiological shock?

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Last updated: April 10, 2025View editorial policy

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From the Guidelines

High-flow oxygen should not be routinely administered to patients in physiological shock, instead, a reservoir mask at 15 L/min should be initiated to aim for a saturation range of 94–98%. When managing patients in physiological shock, it is crucial to consider the most recent and highest quality evidence, such as the BTS guideline for oxygen use in adults in healthcare and emergency settings 1. This guideline recommends initiating treatment with a reservoir mask at 15 L/min and aiming for a saturation range of 94–98% in critical illness, including major trauma, sepsis, shock, and anaphylaxis.

Some key points to consider when administering oxygen to patients in physiological shock include:

  • Initiating treatment with a reservoir mask at 15 L/min to aim for a saturation range of 94–98% 1
  • Maintaining a saturation of 94–98% using lower concentrations of oxygen in patients with spontaneous circulation and a reliable oximetry reading 1
  • Considering the risk factors for hypercapnia pending the results of blood gas measurements and expert assessment 1

It is essential to prioritize the patient's oxygen saturation levels and adjust the oxygen therapy accordingly to ensure adequate tissue oxygenation and prevent complications. However, oxygen therapy alone is insufficient, and concurrent treatment of the underlying cause of shock remains essential for patient survival. The goal of oxygen therapy in physiological shock is to maximize the oxygen content in arterial blood, supporting vital organ function while definitive treatment is implemented.

From the Research

Routine Use of Administering Hi Flow Oxygen to Patients in Physiological Shock

  • There is no direct evidence in the provided studies to support the routine use of administering hi flow oxygen to patients in physiological shock.
  • The studies focus on the use of vasopressors and inotropes in the management of shock, as well as the pathophysiology and treatment options for different types of shock 2, 3, 4.
  • The management of hemorrhagic shock is discussed in one study, which emphasizes the importance of stopping the hemorrhage and refilling the heart with blood to prevent ischemic damage to the brain and heart 5.
  • Another study provides an overview of diagnostic approaches and treatment strategies for patients in shock, but does not mention the use of hi flow oxygen 6.
  • Overall, the provided studies do not provide evidence to support the routine use of administering hi flow oxygen to patients in physiological shock, and instead focus on other aspects of shock management 2, 3, 4, 5, 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Vasopressor and Inotrope Therapy in Cardiac Critical Care.

Journal of intensive care medicine, 2021

Research

A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.

Journal of intensive care medicine, 2024

Research

Shock: aetiology, pathophysiology and management.

British journal of nursing (Mark Allen Publishing), 2022

Research

[Shock - Review for Clinicians].

Deutsche medizinische Wochenschrift (1946), 2019

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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