Oxygen therapy - indications, administration, devices.
BRITISH THORACIC SOCIETY ACUTE OXYGEN GUIDELINES (2017) BTS Guideline for oxygen use in healthcare and emergency settings. Thorax; 72:Suppl.I, i1–89

• excellent and comprehensive, including target saturation for different patients

• definitive information on long-term and ambulatory oxygen

BTS (2009) Guidelines for home oxygen in children. Thorax; 64:Suppl.II

AUSTRALIA AND NEW ZEALAND GUIDELINES (2015) Clinical Practice Guideline: acute oxygen use in adults. Respirology, 20:1182–1191. doi: 10.1111/resp.12620

AARC GUIDELINES: Oxygen therapy in the acute care facility (2002). Respir Care, 47, 6, 717–720

AARC GUIDELINES: Oxygen therapy in the home or alternate site health care facility (2007) Respir Care, 52, 1, 1063-8

IMPRESS GUIDELINES on rationalising oxygen use (2011 revision):


Abdo WF, Heunks LMA (2012) Oxygen-induced hypercapnia in COPD: myths and facts. Critical Care; 16:323

Abernethy AP, McDonald CF, Frith PA (2010) Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet, 376, 9743, 784-93
• oxygen does not relieve breathlessness

Agarwal R, Gupta D (2005) What are high-flow and low-flow oxygen delivery systems? Stroke, 36, 2066-7
• letter clarifying the difference between flow and percentage.

Aguiar C, Davidson J, Carvalho A et al (2015) Tubing length for long-term oxygen therapy. Respir Care; 60(2):179-182
• for LTOT with cylinders and concentrators, up to 30 m of tubing can be used for flows up to 5 l/m

Anderson KJ, Harten JM, Booth MG (2010) The cardiovascular effects of normobaric hyperoxia in patients with heart rate fixed by permanent pacemaker. Anaesthesia, 65, 2, 167-71

Andrianopoulos V et al (2014) Exercise-induced oxygen desaturation in COPD patients without resting hypoxemia. Respir Physiol Neurobiol; 190:40-6. doi: 10.1016/j.resp.2013.10.002

Assimacopoulos EM, Liao J, Heard JP et al (2016) The national incidence and resource utilization of burn injuries sustained while smoking on home oxygen therapy. J Burn Care Res; 37(1):25-31. doi: 10.1097/BCR.0000000000000291

Austin MA, Wills KE (2010) Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting. BMJ, 341, c5462
• titrated oxygen by nasal cannulae in acute COPD patients lowers mortality compared to uncontrolled oxygen via non-rebreather face mask

Benditt JO (2000) Adverse effects of low-flow oxygen therapy. Respir Care, 45, 54-61

Blakeman TC (2013) Evidence for oxygen use in the hospitalized patient: is more really the enemy of good? Respir Care; 58(10):1679-93

Bolton CE, Annandale JA (2006) Comparison of an oxygen concentrator and wall oxygen in the assessment of patients undergoing long term oxygen therapy assessment. Chron Respir Dis. 3, 49-51
• assessment for LTOT must be with the same delivery device that is to be used at home

Bräunlich J, Köhler M, Wirtz H (2016) Nasal highflow improves ventilation in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2016;11:1077-1085. doi:10.2147/COPD.S104616

Cabello JB et al (2013) Oxygen therapy for acute myocardial infarction. Cochrane Database of Systematic Reviews, 8. no: CD007160. doi: 10.1002/14651858.CD007160.pub3
• following normoxaemic myocardial infarction, oxygen therapy may cause harm by reduction in coronary artery blood flow, increase in coronary vascular resistance, decrease in stroke volume and cardiac output, and reperfusion injury from oxygen free radicals

Casanova C (2006) Twenty-four-hour ambulatory oximetry monitoring in COPD patients with moderate hypoxemia. Respir Care, 51, 12, 1416-23
• twenty-four hour oximetry is required because of the difference in diurnal desaturations

Chadha TS (1983) Noninvasive treatment of pneumothorax with oxygen inhalation. Respiration, 44, 147-52
• pneumothorax of less than 30% resolves 3 times quicker with high percentage oxygen

Chikata Y, Unai K, Izawa M et al (2016) Inspiratory tube condensation during high-flow nasal cannula therapy: a bench study. Respir Care; 61(3):300-305. doi: 10.4187/respcare.04331

Chikata Y, Onodera M, Oto J et al (2017) FIO2 in an adult model simulating high-flow nasal cannula therapy. Respir Care; 62(2):193-8
• high-flow nasal cannula do not always deliver an accurate FiO2

Chow JW, Khullar K, Katechia K et al (2016) Controlled oxygen therapy at emergency department presentation increases the likelihood of achieving target oxygen saturations in patients with exacerbations of chronic obstructive pulmonary disease. Emerg Med Austr; 28(1):44-7. doi: 10.1111/1742-6723.12528
• in acute COPD patients, only 16% achieved their target SpO2

Cohen AS, Burns B, Goadsby PJ (2009) High-flow oxygen for treatment of cluster headache. JAMA, 302, 22, 2451-2457
• high-flow oxygen facilitates pain relief at 15 minutes

Cranston J et al (2008) Oxygen therapy for dyspnoea in adults. Cochrane Database of Systematic Reviews, Issue 3.

Cullen DL, Koss JA (2004) A comparison of oxygen tubing lengths and flow output with home oxygen equipment. Eur Respir J, 24: Suppl. 48, 517s
• flowrate for long-term oxygen needs to be increased as tubing length increases

Cuquemelle E, Pham T, Papon JF et al (2012) Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respir Care, 57(10):1571-7

Douglas RM, Bowden K, Pattison J et al (2013) Intermittent hypoxia and hypercapnia induce pulmonary artery atherosclerosis and ventricular dysfunction in low density lipoprotein receptor deficient mice. J Appl Phys; 115(11):1694-1704. doi:10.1152/japplphysiol.00442.2013

Dyer F, Callaghan J, Cheema K, Bott J (2012) Ambulatory oxygen improves the effectiveness of pulmonary rehabilitation in selected patients with chronic obstructive pulmonary disease. Chron Respir Dis, 9(2):83-91.

Eastwood G, Bellomo R, Bailey M et al (2012) Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Medicine; 38(1):91-8
• association between hypoxia and mortality

Elphick HE, Mallory G (2013) Oxygen therapy for cystic fibrosis. Cochrane Syst Rev; Jul 25;7:CD003884. doi: 10.1002/14651858.CD003884.pub4

Eovaldi B, Zanetti C (2010) Hyperbaric oxygen ameliorates worsening signs and symptoms of post-traumatic stress disorder. Neuropsychiatr Dis Treat, 6, 785–789

Fardy HJ (2016) Oxygen therapy in palliative care. NPJ Prim Care Respir Med; 26:15073. doi: 10.1038/npjpcrm.2015.73

Feitosa MR, Féres Filho O, Tamaki CM et al (2016) Adjunctive hyperbaric oxygen therapy promotes successful healing in patients with refractory Crohn's disease. Acta Cir Bras; 31 Suppl 1:19-23. doi: 10.1590/S0102-86502016001300005

Franchini ML, Athanazio R, Amato-Lourenço LF et al (2016) Oxygen with cold bubble humidification is no better than dry oxygen in preventing mucus dehydration, decreased mucociliary clearance, and decline in pulmonary function. Chest; 150(2):407-14. doi: 10.1016/j.chest.2016.03.035

Frat JP, Brugiere B, Ragot S et al (2015) Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. Respir Care; 60(2):170-178

García-Talavera I, Figueira-Gonçalves JM (2016) Ambulatory oxygen therapy in COPD patients with oxygen desaturation during exercise. Chr Obstr Pulm Dis Open Access; 1:1

Gaunt KA, Spilman SK, Halub ME et al (2015) High-flow nasal cannula in a mixed adult ICU. Respir Care; 60(10):1383-1389

Gomersall GD et al (2002) Oxygen therapy for hypercapnic patients with COPD and acute respiratory failure. Crit Care Med, 30, 113-116

Górecka D (2004) Short burst oxygen therapy is unhelpful? Chr Respir Dis, 1, 99-100

Groves N, Tobin A (2007) High flow nasal oxygen generates positive airway pressure in adult volunteers. Austr Crit Care, 20, 4, 126-131
• CPAP generated by high-flow nasal oxygen

Hale KE, Gavin C, O'Driscoll BR (2008) Audit of oxygen use in emergency ambulances and in a hospital emergency department. Emerg Med J, 25(11): 773–6
• oxygen is underused in critical illness

Hedenstierna G (2012) Oxygen and anesthesia: what lung do we deliver to the post-operative ward? Acta Anaesthesiol Scand; 56(6):675-85. doi: 10.1111/j.1399-6576.2012.02689.x

Heunks MA, Abdo WF (2012) Oxygen-induced hypercapnia in COPD:
myths and facts. Crit Care, 16, 323-6

Hovaguimian F et al (2013) Effect of intraoperative high inspired oxygen fraction on surgical site infection, postoperative nausea and vomiting, and pulmonary function: systematic review and meta-analysis of randomized controlled trials. Anesthesiology;119(2):303-16
• high FiO2 delivered intraoperatively reduces wound infections and slightly reduces nausea

Itagaki T, Okuda N, Tsunano Y et al (2014) Effect of high-flow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients. Respir Care; 59(1):70–74

Jones PG, Sinan K, Doran OD (2016) Randomized controlled trial of humidified high-flow nasal oxygen for acute respiratory distress in the emergency department: the HOT-ER study. Respir Care; 61(3):291—299

Kane B, Decalmer S, O’Driscoll R (2013) Emergency oxygen therapy: from guideline to implementation. Breathe;9:246-253

Kaur S, Pawar M, Banerjee N et al (2012) Evaluation of the efficacy of hyperbaric oxygen therapy in the management of chronic nonhealing ulcer and role of periwound transcutaneous oximetry as a predictor of wound healing response: A randomized prospective controlled trial. J Anaesthesiol Clin Pharmacol, 28(1): 70–75

Kim JH (2016) Can a high-flow nasal cannula substitute for noninvasive positive pressure ventilation in post-extubation respiratory failure? Korean J Intern Med; 31(1):36-39. doi: 10.3904/kjim.2016.31.1.36

Kranke P, Bennett MH, Martyn-St James M et al (2015) Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 24;6:CD004123. doi: 10.1002/14651858.CD004123.pub4

Leach RM, Bateman NT (1993) Acute oxygen therapy. Br J Hosp Med. 49, 637-44
• good clear explanation of different masks
• type II RF occurs in 10-15% of acute COPD patients
• flow rates < 5 L/min can cause rebreathing of exhaled CO2

LeBlanc CJ, Lavallée LG, King JA et al (2013) A comparative study of 3 portable oxygen concentrators during a 6-minute walk test in patients with chronic lung disease. Respir Care; 58(10):1598-605

Lemiale V, Mokart D, Mayaux J et al (2015) The effects of a 2-h trial of high-flow oxygen by nasal cannula versus Venturi mask in immunocompromised patients with hypoxemic acute respiratory failure: a multicenter randomized trial. Crit Care; 19:380

Littleton SW (2015) Hypercapnia from hyperoxia in COPD: another piece of the puzzle or another puzzle entirely? Respir Care; 60(3):473-475

Martin DS, Grocott MPW (2013) Oxygen therapy in anaesthesia: the yin and yang of O2. Br J Anaesth; 111(6):867-71. doi:10.1093/bja/aet291
Mulloy E (1996) Ventilation and gas exchange during sleep and exercise in severe COPD. Chest, 109, 387-94.
• saturation falls twice as much during sleep as during maximal exercise

Murphy R (2001) Emergency oxygen therapy for the COPD patient. Emerg Med J, 18, 333 - 9.
• literature review on how much oxygen is OK for COPD patients, easy reading due to key point summaries

Nadal A (2013) Linking intermittent hypoxia, sympathetic response and metabolic disturbances. Acta Physiologica, 209:7–8. doi: 10.1111/apha.12137

Nagata K, Morimoto T, Fujimoto D et al (2015) Efficacy of high-flow nasal cannula therapy in acute hypoxemic respiratory failure: decreased use of mechanical ventilation. Respir Care; 60(10):1390-1396

Nedel WL, Deutschendorf C, Rodrigues F et al (2017) High-flow nasal cannula in critically ill subjects with or at risk for respiratory failure: a systematic review and meta-analysis. Respir Care; 62(1):123-132

Nishimura M (2016) High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care; 61(4):529-541

O'Brien J (2013) Absorption atelectasis: incidence and clinical implications. AANA J; 81(3):205-8

O'Driscoll BR (2011) Safe use of emergency oxygen in chronic respiratory disease. Chron Respir Dis, 8, 159-161.
• oxygen for acute-on-chronic lung disease: COPD, asthma, CF, restrictive disease, lung cancer

Oliveira MF, Rodrigues MK, Treptow E et al (2012) Effects of oxygen supplementation on cerebral oxygenation during exercise in chronic obstructive pulmonary disease patients not entitled to long-term oxygen therapy. Clin Physiol Functional Imag, 32, 1, 52-8
• ambulatory oxygen improves cerebral oxygenation

Nishimura M (2015) High-flow nasal cannula oxygen therapy in adults. J Intensive Care; 3(1):15. doi: 10.1186/s40560-015-0084-5. eCollection 2015.

Pannu SR, Dziadzko MA, Gajic O (2016) How much oxygen? oxygen titration goals during mechanical ventilation. Am J Respir Crit Care Med; 193(1):4-5. doi: 10.1164/rccm.201509-1810ED
• in the ICU, excess oxygen may contribute to reperfusion injury

Parke RL, Bloch A, McGuinness SP (2015) Effect of very-high-flow nasal therapy on airway pressure and end-expiratory lung impedance in healthy volunteers. Respir Care; 60(10):1397-1403

Peel D, Neighbour R, Eltringham RJ (2013) Evaluation of oxygen concentrators for use in countries with limited resources. Anaesthesia, 68: 706–712. doi: 10.1111/anae.12260

Revill SM, Noor NZ, Butcher G (2010) The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen. Chronic Resp Dis, 7, 4, 239-45
• the endurance shuttle walk test is more responsive than the six-minute distance for detecting improvements in walking endurance with ambulatory oxygen

Rittayamai N, Tscheikuna J, Praphruetkit N et al (2015) Use of high-flow nasal cannula for acute dyspnea and hypoxemia in the emergency department. Respir Care; 60(10):1377-1382

Rizzi M, Airoldi A, Cristiano A et al (2016) Oxygen therapy in COPD patients with isolated nocturnal hypoxemia; comparison of quality of life and sleep between bronchitis and emphysema phenotype: a prospective observational study. Europ J Internal Med; 34: 78–84
• people with emphysema who demonstrate nocturnal desaturation show improved cognition and QoL with nocturnal oxygen therapy

Roberts CD, Oeckler RA (2015) A skeptical perspective on high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. Respir Care; 60(10):1522-1525

Roffe C, Frohnhafen H, Sills S et al (2010) Frequency of nocturnal hypoxia in clinically stable patients during stroke rehabilitation. Clin Rehabil, 24, 267-75
• nocturnal desaturations are common in stable stroke patients.

Roca O, Hernández G, Díaz-Lobato S et al (2016) Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure. Crit Care; 20:109

Samaja M, Milano G (2015) Hypoxia and reoxygenation: from basic science to bedside. Frontiers Pediatrics; 19 October. dx.doi.org/10.3389/fped.2015.00086

Silva ALG, Karnopp TE, Weber AF et al (2016) DNA damage and repair capacity in lymphocyte of chronic obstructive pulmonary diseases patients during physical exercise with oxygen supplementation. Multidisciplinary Respir Med; 11:43. doi: 10.1186/s40248-016-0079-7

Sim MAB, Dean P, Kinsella J (2008) Performance of oxygen delivery devices when the breathing pattern of respiratory failure is simulated. Anaesthesia, 63, 938-40.
• the typical breathing pattern adopted in respiratory failure leads to reduced FiO2.

Spielmanns M, Fuchs-Bergsma C, Winkler A et al (2015) Effects of oxygen supply during training on subjects with COPD who are normoxemic at rest and during exercise: a blinded randomized controlled trial. Respir Care; 60(4):540-548

Spoletini G, Hill NS (2016) High-flow nasal oxygen versus noninvasive ventilation for hypoxemic respiratory failure: Do we know enough? AnnThorac Med; 11(3):163-166. doi: 10.4103/1817-1737.185760.

Wong GW, Finnis ME (2010) Use of venturi entrainment to deliver nasal high flow oxygen. Crit Care Shock, 13:75-80

Yamamoto N, Miyashita T, Takaki S et al (2015) Effects of breathing pattern on oxygen delivery via a nasal or pharyngeal cannula. Respir Care; 60(12):1804-1809

Yao HH, Tuck MV, McNally C et al (2015) Gastric rupture following nasopharyngeal catheter oxygen delivery-a report of two cases. Anaesth Intensive Care; 43(2):244-8

Yip YY (2013) Performance of a new oxygen delivery device for potentially infectious critically ill patients. Anaesthesia, 68(10):1038–1044
• high-flow oxygen facilitates transmission of some respiratory infections

Young P (2005) Ambulatory and training oxygen: a review of the evidence and guidelines for prescription. NZ J Physiother, 33, 1, 7-12
• everything you always wanted to know about oxygen prescription for both exercise training and home use - succinct and evidence-based.

AARC = American Association for Respiratory Care
ABG = arterial blood gas
ACPRC = Association of Chartered Physiotherapists in Respiratory Care
ATS = American Thoracic Society
BTS = British Thoracic Society
CF = cystic fibrosis
ERS = European Respiratory Society
FiO2 = fraction of inspired oxygen concentration
ILD = interstitial lung disease
JAMA = Journal of American Medical Association
l/m = litres per minute
LTOT = long term oxygen therapy
SOB = shortness of breath