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Clinician Article

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



  • Siemieniuk RAC
  • Chu DK
  • Kim LH
  • Guell-Rous MR
  • Alhazzani W
  • Soccal PM, et al.
BMJ. 2018 Oct 24;363:k4169. doi: 10.1136/bmj.k4169. (Review)
PMID: 30355567

Disciplines
  • Hospital Doctor/Hospitalists
    Relevance - 7/7
    Newsworthiness - 6/7
  • Internal Medicine
    Relevance - 7/7
    Newsworthiness - 6/7
  • Cardiology
    Relevance - 7/7
    Newsworthiness - 5/7
  • Respirology/Pulmonology
    Relevance - 7/7
    Newsworthiness - 4/7
  • Intensivist/Critical Care
    Relevance - 6/7
    Newsworthiness - 6/7
  • Neurology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Emergency Medicine
    Relevance - 6/7
    Newsworthiness - 5/7

Abstract

This item does not have an abstract.


Clinical Comments

Cardiology

This guidance gives important guidance to the physicians. I would like to see more evidence for the 2nd recommendation.

Cardiology

Recent years' insights into the role of Oxygen as a drug remind us that all effective drugs have the potential for adverse results, and that supplemental Oxygen is no different in this regard. The piecemeal observations published over the past decade, however, have not previously been summarized in the form of actionable recommendations. This working guideline from Siemieniuk et al, fills an important near-term gap to guide thoughtful Oxygen therapy in Medical and Surgical patients; it will no doubt be revised, debated, and revisited in the coming few years but is an intellectually defensible and sound guideline for working clinicians based on the current evidence.

Hospital Doctor/Hospitalists

This is an important and frequently encountered situation where providers often vary from evidence-based best practices. A must-read for hospitalist providers.

Hospital Doctor/Hospitalists

This is an important paper revising conventional unproven clinical practices. It would be very beneficial to include these results into guidelines for treatment.

Intensivist/Critical Care

This is a concise and useful guideline.

Internal Medicine

An excellent update on what the literature supports for oxygen use in various settings.

Internal Medicine

This would be a major change in how general medicine inpatients are treated, where supplemental oxygen is often viewed as a comfort measure without any harm.

Neurology

This has been posted in the 'Neurology' section but has implications for all aspects of medicine. The methods are robust and the findings challenge existing dogma. It is interesting that the recommendations made here do not align with recent guidance on use of oxygen published by the British Thoracic Society - yet both author groups were working with the same evidence.

Neurology

The paper provides evidence-based guidelines about when oxygen therapy should be started and how much oxygen should be given based on capillary oxygen saturation specifically in critically ill patients. This is valuable information which few practitioners know and the knowledge should change their practice.

Respirology/Pulmonology

Whether or not pulmonary practitioners are aware of this guideline, this paper is a highly worthwhile and well done read and is a commendable example of facilitation of the translation of research into practice. It should be core reading for trainees in all specialties likely to administer supplemental oxygen. If there is any criticism, it is the under-emphasis of the same SpO2 target range for mechanically ventilated patients. Targeting SpO2 of 100% is an outdated and potentially harmful practice. This paper is a helpful antidote that should be widely deployed.

Respirology/Pulmonology

This is a nice review of the available data. The recommendations in the guideline go beyond the data and are provocative, although not entirely driven by the evidence. While I have a bias that tends to agree with the guideline recommendations, I don`t think the evidence is quite definitive enough for lower oxygen saturations to truly be the new standard.

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