Prehospital use of supplemental oxygen therapy in the non-hypoxic patient

After completing this module the paramedic will be able to:

The use of supplemental oxygen therapy—the administration of oxygen for medicinal purposes—in the prehospital setting can be life-saving in the treatment of hypoxaemia. However, it is often administered liberally in a routine manner and without clinical indication (Eskesen et al, 2018). In cases of hyperoxaemia, oxygen is also known to be associated with an increased risk of morbidity and mortality in acutely ill patients, such as those with stroke, myocardial infarction (MI) and chronic obstructive pulmonary disease (COPD) (Branson and Johannigman, 2012; Cornet et al, 2013; Stolmeijer et al, 2018).

In acute exacerbations of COPD, the administration of high-flow oxygen is related to longer hospital stays, admission to high-dependency units, acidosis, hypercapnia and mortality (Austin et al, 2010; Ringbaek et al, 2015). According to Austin et al (2010), one in every 14 patients with COPD treated with high-flow oxygen in the prehospital setting will die, although these risks can be reduced by up to 78% if titrated instead. High-flow oxygen is defined by the British Thoracic Society (BTS) as 8–10 litres/minute, while titration refers to tailoring the oxygen dose to suit the patient's needs (O'Driscoll et al, 2008).