Some studies have shown that over-oxygenating a patient (aiming for saturations 96-100%) is associated with an increased risk of death in acute illnesses. 8

Oxygen - delivery devices - Oxford Medical Education

However, this is NOT a long-term solution, and unless they can be titrated down, patients will need to be transitioned to a BIPAP, HFNC, or intubation, unless they can be titrated down. Ventilators have various settings which control the respiratory rate, the IPAP, the EPAP, the inspiratory flow rate, and the FIO2%. If a patient’s oxygen requirements increase so much that they do not respond to 15L/min via a non-rebreather mask: Flow rate (oxygen flow rate is set on the O2 wall tap) is shown on mask along with the % O2 delivery. Each colour must be used with a given flow rate (written on the mask) to give the correct oxygen percentage. When conventional delivery methods are not tolerated, wafting of oxygen via a face mask has been shown to deliver concentrations of 30% - 40% with 10 litres oxygen per minute, to an area of 35 x 32cms from top of the mask. Wafting via green oxygen tubing has been assessed as appropriate for short- term use only, i.e., whilst feeding. A standard paediatric oxygen mask placed on the chest can give significant oxygen therapy with minimal distress to the patient (11).F9. In acute heart failure, aim at an oxygen saturation of 94–98% (or 88–92% if the patient is at risk of hypercapnic respiratory failure) (grade D). Once stable, if there is a reliable oximetry reading then titrate oxygen to aim saturations at 94-98% (88-92% if ABG confirms hypercapnic respiratory failure). F10. Continuous positive airway pressure (CPAP) with entrained oxygen or high-flow humidified nasal oxygen to maintain saturation 94-98% (or 88-92% if at risk of hypercapnia) should be considered as an adjunctive treatment to improve gas exchange in patients with cardiogenic pulmonary oedema who are not responding to standard treatment (or non-invasive ventilation (NIV) if there is co-existant hypercapnia and acidosis) (grade B).

Oxygen | Treatment summaries | BNFC | NICE Oxygen | Treatment summaries | BNFC | NICE

Any changes in oxygen should be documented on the patient’s observation chart and signed for by nursing staff on drug chart. If oxygen needs to be prescribed, you should also take a systematic approach to identify why the patient has desaturated. Always involve a senior clinician if you are concerned or unsure how to manage the patient.If the patient uses a venti mask for oxygen, the flow meter is always set at 15 liters. The mask has different color-changeable plastic pieces. Besides, each color signifies a different oxygen delivery percentage. Being said that, it can deliver between 24 to 50 percent of oxygen.

Oxygen Pro Canister with Inhaler Cup - 15 litres of 99.5% Oxygen Pro Canister with Inhaler Cup - 15 litres of 99.5%

My second question for you is this: what is the FiO2 of the oxygen being delivered through the flow meter as soon as you turn it on? D3. If medium-concentration therapy with nasal cannulae or a simple face mask does not achieve the desired saturation, change to a reservoir mask and seek senior or specialist advice (grade D). F14. High concentrations of oxygen should be avoided in patients with stroke, unless required to maintain normal oxygen saturation. Aim at an oxygen saturation of 94–98% or 88–92% if the patient is at risk of hypercapnic respiratory failure (grade D). It is a post COVID condition in which patient becomes oxygen dependent due to progressive lung fibrosis which enables to bring down oxygen requirement. Used for emergency situations (Advanced Life Support Group, 1997) due to a large reservoir that allows oxygen only to be breathed in by the child. This prevents the inhalation of mixed gases. The approximate inspired oxygen received is 99% (10).Monitor Early Warning Score (CEWS) and respiratory rate for further clinical signs of deterioration This formula is limited to normal circumstances. Several factors are affecting our FiO2, which include: High-flow Nasal cannula consists of a specific machine and tubing used to deliver a very high flow of oxygen that is heated and humidified.

NHSAAA Medicines - Guidelines on Oxygen and Oximetry

An NPSA rapid response report ‘Oxygen safety in hospitals’ in 2009 reported 281 serious incidents from Dec 2004 to June 2009 relating to oxygen therapy and that poor oxygen management caused 9 deaths and contributed to a further 35. This report placed an obligation on hospitals to introduce measures to reduce avoidable harm associated with administration of oxygen. In fact saturations of 100% are less helpful than 98-99% as they can reflect a normal PaO2 (10-13 kPa) but may also reflect an inappropriately high kPa of e.g. 30 (in an over-oxygenated patient) Oxygen is not always added (especially if the patient is just using it for OSA). The pressure is set at 5-20 cm H2O, usually beginning at 5-8 cm H2O.

Since oxygen is a drug, it must be prescribed on a drug chart (paper or electronic). Most drug charts have a section for oxygen prescribing. CPAP= continuous positive airway pressure = high pressure air/oxygen with a tight fitting mask. Positive pressure all the time. Clinicians must bear in mind that supplemental oxygen is given to improve oxygenation, but it does not treat the underlying causes of hypoxaemia which must be diagnosed and treated as a matter of urgency.