Oxygen therapy for medical patients

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 …