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What Should Be The Target Oxygen Saturation Range For Patients Receiving Supplementary Oxygen

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8.7.1 Oxygen saturation target range for most patients

As discussed in sections 46 of this guideline, there is no evidence of benefit from above normal oxygen saturation in most medical emergencies and there is evidence that excessive doses of oxygen can have adverse effects, even in some patients who are not at risk of hypercapnic respiratory failure. A target oxygen saturation range of 9498% will achieve normal or near normal oxygen saturation for most patients who are not at risk of hypercapnic respiratory failure. Furthermore, the suggested lower limit of 94% allows a wide margin of error in the oximeter measurement, thus minimising the risk of any patient being allowed to desaturate below 90% due to inaccurate oximetry.

8.7.2. Oxygen requirements for specific groups of patients

  • Patients with critical illness requiring high dose oxygen therapy are discussed in section 8.10.

  • Patients with medical emergencies which frequently cause breathlessness and hypoxaemia are discussed in section 8.11.

  • Patients with COPD and other conditions that may predispose to type 2 respiratory failure are discussed in section 8.12.

  • Medical emergencies for which oxygen is commonly given at present but is not actually indicated unless the patient is hypoxaemic are discussed in section 8.13.

Need For A Guideline For Emergency Oxygen Therapy And Purpose Of The Guideline

There is considerable controversy concerning the benefits and risks of oxygen treatment in virtually all situations where oxygen is used. Unfortunately, this is an area of medicine where there are many strongly-held beliefs but very few randomised controlled trials. The only published UK guideline for emergency oxygen therapy is the North West Oxygen Guideline published in 2001, based on a systematic literature review by the same authors. Against this background, the Standards of Care Committee of the British Thoracic Society established a working party in association with 21 other societies and colleges listed at the front of this document. The objective was to produce an evidence-based and up-to-date guideline for emergency oxygen use in the UK.

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Patients With Known Copd

A proportion of breathless patients will have COPD . Unfortunately, a recent Cochrane review of oxygen therapy for COPD in the prehospital setting found no relevant studies.

Audits of emergency admissions in UK hospitals have shown that about 25% of breathless medical patients who require hospital admission have COPD as a main diagnosis. Many of these patients will require carefully controlled oxygen therapy because they are at risk of carbon dioxide retention or respiratory acidosis. In a large UK study, 47% of patients with exacerbated COPD had Paco2> 6.0 kPa , 20% had respiratory acidosis and 4.6% had severe acidosis . Acidosis was more common if the blood oxygen was > 10 kPa . Plant and colleagues recommended that patients with acute COPD should be maintained within a Pao2 range of 7.310 kPa to avoid the dangers of hypoxaemia and acidosis.

Recommendation

  • Patients with COPD should initially be given oxygen via a Venturi 28% mask at a flow rate of 4 l/min or a 24% Venturi mask at a flow rate of 2 l/min. Some patients may benefit from higher flow rates via the Venturi mask . The target oxygen saturation should be 8892% in most cases or an individualised saturation range based on the patients blood gas measurements during previous exacerbations.

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Light interacts with cells in unique ways. Your cells are capable of converting light into energy, which helps them work harder and reproduce faster. Light also triggers the recovery process in your muscles. Having healthier cells and relaxed muscles will reduce the amount of pain you experience from medical conditions, injuries, and everyday fatigue.

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Safe Prescription And Administration Of Oxygen

11.1.1 Legal status of medical oxygen: does it need a prescription?

Medical oxygen is a drug. However, the legal status of oxygen in the UK is that of a medicinal product on the General Sales List . This means that the sale or dispensation of oxygen does not technically require a prescription because it is not a prescription only medicine. This status was conferred for practical reasons to facilitate the use of oxygen in the domiciliary setting where the distribution system no longer involves pharmacies. However, the use of oxygen by paramedics, nurses, doctors, physiotherapists and others in emergency situations is similar to the use of all other medicinal products by these people. Clinical governance requires that the intentions of the clinician who initiates oxygen therapy should be communicated clearly to the person who actually administers oxygen to the patient and an accurate record must be kept of exactly what has been given to the patient. In this respect, oxygen is in the same category as paracetamol, aspirin, ibuprofen, antihistamines, anti-emetics and many other medicines that do not require a prescription if purchased by a patient for his/her own use but do require accurate documentation if administered by a health professional to a patient. In healthcare settings, all of these medicines are conventionally recorded on a prescription chart or drug kardex alongside drugs in the prescription only category such as antibiotics.

Recommendations

Assessment And Immediate Management Of Breathless Patients On Arrival In Hospital

Breathless patients may arrive in hospital directly or in ambulances where they will usually have been assessed by paramedics who may also have initiated emergency treatments including oxygen therapy. As discussed in section 7 of this guideline, assessment, triage and resuscitation of critically ill patients must be undertaken in parallel with the initiation of oxygen therapy and specific treatment must be given for the underlying medical condition. All critically ill patients and all patients at risk of hypercapnic respiratory failure should be triaged as very urgent and should have blood gases taken on arrival in hospital. Furthermore, all seriously ill patients should be assessed by senior clinicians as early as possible. In many cases this may involve liaison with intensive care specialists or with appropriate other specialists who can deal effectively with the patients major medical or surgical problems.

  • Readers are referred to section 7.1.1 and to disease-specific guidelines for advice concerning the immediate assessment and management of seriously ill patients.

  • Readers are referred to section 10 for advice concerning choice of oxygen delivery devices and systems.

  • Readers are referred to and charts 1 and 2 for a summary of the key elements of oxygen therapy in common medical emergencies.

  • Remember to ask for senior advice or specialist advice early in the care of profoundly ill patients.

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Pulse Oximetry And Availability Of Oxygen

It is essential to provide optimal oxygen therapy at the earliest possible opportunity while the acutely breathless patient is being assessed and treated in the community and during transfer to hospital. For most such patients the main concern is to give sufficient oxygen to support their needs. Hypoxaemia can lead to cardiac arrhythmias, renal damage and, ultimately, cerebral damage. However, excessive oxygen therapy can also be dangerous for some patients, especially those with advanced COPD. Target saturation should be used pulse oximetry is necessary to achieve this. Section 10.4.2 provides advice concerning the choice of oxygen cylinders in primary care practices.

Emergency ambulances and emergency/fast response type vehicles and ambulance service motorbikes and cycles should be equipped with oxygen and oximeters germane to the mode of transport. Thus, fast response cars/motorbikes and cycles will require handheld finger oximeter-type devices and staff initiating oxygen in the home will need a portable or finger oximeter. Community First Responder schemes are encouraged to seek the opinion of the ambulance service to which they are affiliated to discuss the purchase and use of pulse oximeters. Likewise Voluntary Aid Societies medical directors are encouraged to discuss the purchase and use of pulse oximieters.

Recommendations

18.Pulse oximetry must be available in all locations where emergency oxygen is being used .

Effects Of Body Positioning Including Restraint Systems

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Appropriate positioning of a patient can maximise V/Q matching. In the healthy self-ventilating adult lung, V/Q matching improves from non-dependent to dependent areas. In lung disease there is a disruption of this pattern and, in these instances, appropriate positioning may be advantageous in optimising V/Q matching, therefore improving gas exchange, oxygenation and carbon dioxide clearance. For these reasons, breathless patients usually prefer to sit upright or near upright provided they are able to do so.

The relationship between dependency and V/Q matching is maintained irrespective of the position of the subject. The physiology is then transferable into alternate side lying positions for example, in left side lying the dependent lung will have the better V/Q matching. This is important in the presence of asymmetrical lung pathology as the good lung down principle will maximise V/Q matching.

The semi-recumbent/supine position is commonly adopted in an ambulance. In addition, for safety, the patient is strapped into the stretcher using abdominal and chest restraints with their arms by their side. While there are a lack of specific data regarding this, physiological principles suggest that the use of such positioning and restraints would compromise both respiratory muscle function and gas exchange.

Recommendation

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Areas Not Covered By This Guideline

  • Oxygen use in paediatrics: the present guideline applies only to subjects aged 16 years.

  • Oxygen use for high altitude activities.

  • Oxygen use during air travel.

  • Underwater diving and diving accidents.

  • Oxygen use in animal experiments.

  • Oxygen use during surgery and anaesthesia or during endoscopy.

  • Oxygen use in high-dependency units.

  • Oxygen use in intensive care units.

  • Interhospital level 3 transfers.

  • Use of heliox mixtures.

  • Use of nitrous oxide/oxygen mixtures .

  • Respiratory support techniques including intubation, invasive ventilation, non-invasive ventilation and continuous positive airway pressure .

  • Self-initiated use of oxygen by patients who have home oxygen for any reason .

  • Ongoing care of hypoxaemic patients at home.

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Section : Advanced Blood Gas Physiology And Pathophysiology And Physiology Of Oxygen Therapy

Many of the issues discussed in this section are of a technical nature and may not be easily comprehensible to the general reader. However, recommendations 15 in section 6 of the guideline will follow logically from this section and from the brief overview of oxygen physiology in section 4.

The neurocardiopulmonary axis is designed to optimise global oxygen delivery and carbon dioxide clearance and the local tissue vascular beds are responsible for the distribution of blood flow.

Oxygen delivery is expressed by the equation:

Do2 = Cao2 × Q

where Cao2 is the oxygen content of the arterial blood and Q is the cardiac output. Cao2 is the sum of oxygen dissolved in the blood and the amount of oxygen carried by haemoglobin. The solubility of oxygen in the blood is very low and therefore Cao2 is largely determined by the total amount of haemoglobin and the proportion which is bound by oxygen, namely saturation. The relationship between haemoglobin Sao2 and Pao2 is shown in and . In health and disease, haemoglobin saturation is also influenced by other factors such as pH, Pco2, temperature and 2,3 diphosphoglycerate . Consequently, there is not an exact relationship between Sao2 and Pao2 but gives approximate equivalents.

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How The Evidence Was Assimilated Into The Guideline

The initial search strategy was devised at two meetings of the group in 2004 and 2005. The searches in October 2005 yielded 3306 papers, the abstracts of which were checked for relevance by group members. One hundred and eighty-four of these abstracts were considered to be relevant to the present guideline. Full reprints of all relevant papers were obtained. Further references were obtained from the groups personal literature collections and from the references contained within the papers which the search yielded and by focused literature searches by members of the guideline group. The group continued to monitor the literature up to the end of 2007 for important new publications or very high quality abstracts from international meetings that were thought to be relevant to this guideline.

The group was divided into three subgroups to work on specific areas of oxygen use: emergency care hospital care oxygen physiology and devices. Evidence from the literature searches was graded according to the levels of evidence used in the NICE COPD guideline .

Section 1: Areas Requiring Further Research

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Because of the life and death nature of many conditions for which emergency oxygen therapy is used, it seems that clinicians have been wary of conducting controlled trials of oxygen therapy for most of the commoner indications. It is worrying that the few existing trials of oxygen therapy given to non-hypoxaemic patients in common conditions such as heart attacks, strokes and difficult labour have failed to show benefit, and there have been suggestions of possible harm in these trials despite the near universal use of oxygen for such conditions in the past.

Further research is required in many areas including:

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The Revive Led Light Therapy Unbiased Review

We all want to look young and dislike the appearance of wrinkles and aging skin, thats one of the reasons red led light therapy is becoming so popular.

There are plenty of medical studies that have looked into red light therapy, and its benefits. For instance by this study by the US national library medical of library there are obvious anti aging and skin benefits when using red light therapy on patiences skin.

In this post, we wanted to review the popular Revive led light therapy device.

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