Acute oxygen therapy: a review of prescribing and delivery practices

Abstract

Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care.

Keywords: COPD; chronic obstructive pulmonary disease; hypercapnia; hypoxia; oxygen therapy; prescribing; type II respiratory failure.

Figure 1

Timeline of papers published on oxygen therapy prescription and administration practices. Notes: Between 1980 and 2007 (27 years), 17 papers were found. Between 2009 and 2015 (6 years), 12 papers were found. All papers published between 2009 and 2015 measured the accurate or appropriate prescription of oxygen therapy ± various interventions to improve prescription rates.

Figure 2

Accurate prescription of oxygen therapy: preintervention–postintervention study results. Notes: Rates of improvement in prescribing for various interventions.