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Oxygen therapy for medical patients

BMJ 2018; 363 doi: (Published 24 October 2018) Cite this as: BMJ 2018;363:k4436

Linked practice

Oxygen therapy for acutely ill medical patients: a clinical practice guideline

This article has a correction. Please see:

  1. Daniel Horner, professor1 2,
  2. Ronan O’Driscoll, consultant respiratory physician2
  1. 1Royal College of Emergency Medicine, London, UK
  2. 2Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to: Daniel Horner danielhorner{at}

New lower targets will change practice, but evaluation must continue

Oxygen has long been a friend to the medical profession.1 Even old friendships need reappraisal, however, in light of new information. Oxygen therapy in acute medical illness is a friendship past its due date for review.

In a linked paper, Siemieniuk and colleagues publish a set of rapid recommendations2 highlighting the increasingly well known risks of hyperoxia and proposing some radical new targets for future care, based on recently published evidence.3 They propose a target oxygen saturation range of 90-94% for most patients with acute medical illness and no more than 90-92% for those with acute stroke or myocardial infarction. The authors make a strong recommendation against letting saturation rise above 96% in any patient with a medical problem who is receiving supplemental oxygen.

These target ranges are a step change downwards from the 2008 British Thoracic Society guideline (target range 94-98%) and the 2015 Thoracic Society of Australia and New Zealand guideline (target range 92-96%).45 Although technically simple to deliver, these recommendations will require a shift in culture—away from oxygen as a …

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