What are the guideline sources, guidelines and references for Home oxygen ?
Guideline sources The following summarized guidelines for the evaluation and management of home oxygen are prepared by our editorial team based on guidelines from the British Thoracic Society (BTS 2015). 1 Guidelines 1. Screening and diagnosis Indications for assessment: refer patients with a resting oxygen saturation of 92% for a blood gas assessment in order to assess eligibility for long-term oxygen therapy. B Show 2 more 2. Diagnostic investigations Blood gas analysis: obtain an arterial blood gas in patients being assessed for long-term oxygen therapy. A Show 2 more Pulse oximetry: https://web.pathway.md/diseases/recnoQqrXqiEQL0qE 1/5 6/24/23, 12:44 PM Home oxygen Pathway Avoid using pulse oximetry alone to assess the need for long-term oxygen therapy. D Consider using a combination of capillary blood gas and pulse oximetry to assess the need for long-term oxygen therapy in patients in whom arterial blood gas sampling is not possible. Some patients may receive long-term oxygen therapy unnecessarily using this approach, but it is unlikely that any patient would be inappropriately denied long-term oxygen therapy. 3. Medical management General principles: order long-term oxygen therapy for a minimum of 15 hours per day; up to 24 hours per day may be of additional benefit. B Show 2 more Assessment of stability: Avoid ordering long-term oxygen therapy at the time of an acute exacerbation of a patient's underlying condition. Consider assessing patients for long-term oxygen therapy after < 8 weeks of stability, if they exacerbate frequently and are unable to achieve a period of stability lasting 8 weeks. If long- term oxygen therapy is ordered for such patients, they should be counselled that oxygen therapy may no longer be required once they achieve a more stable state. Smoking cessation: Advise smoking cessation prior to ordering home oxygen, and at each follow-up visit if the patient continues to smoke. B Inform patients that the benefit of long-term oxygen therapy may be reduced if tobacco use is not discontinued. B Oxygen delivery device: Use nasal cannulae as the oxygen delivery device of choice for patients requiring home oxygen therapy. Some patients may benefit from or prefer a Venturi mask system. B Consider using a Venturi mask as the oxygen delivery device in patients in whom there are concerns about existing or developing hypercapnic respiratory failure, in patients with a high resting respiratory rate, or in patients with cognitive impairment. Oxygen humidification: Order humidified oxygen for patients receiving oxygen via a tracheostomy. Avoid routinely ordering humidification of home oxygen for patients who do not have tracheostomies. D Oxygen carrying equipment: offer wheeled devices or backpacks to patients in whom these devices can improve ambulation and quality of life. B Nocturnal oxygen therapy: avoid offering nocturnal oxygen therapy to patients with COPD who have nocturnal hypoxemia, but fail to meet criteria for long-term oxygen therapy. D Ambulatory oxygen therapy: offer ambulatory oxygen therapy to patients who are undertaking exercise in the context of a pulmonary rehabilitation program. B https://web.pathway.md/diseases/recnoQqrXqiEQL0qE 2/5 6/24/23, 12:44 PM Home oxygen Pathway Show 2 more Palliative oxygen therapy: Avoid offering palliative oxygen therapy to patients with intractable breathlessness who are not hypoxemic, or have mild hypoxemia above established thresholds (SpO 92%). D Assess patients with intractable breathlessness due to cancer or end-stage cardiorespiratory disease for a trial of treatment with opioids from an appropriately trained healthcare professional. A Short-burst oxygen therapy: avoid offering short-burst oxygen therapy for use prior to or following exercise in patients with COPD. D 4. Specific circumstances Patients with chronic obstructive pulmonary disease: offer long-term oxygen therapy to patients with stable COPD and a resting PaO 55 mmHg (7.3 kPa). A Show 2 more Patients with interstitial lung disease: Offer long-term oxygen therapy to patients with ILD and a resting PaO 55 mmHg (7.3 kPa). B Offer long-term oxygen therapy to patients with ILD, a resting PaO 60 mmHg (8 kPa), and either peripheral edema, polycythemia (hematocrit 55%), or evidence of pulmonary hypertension. B Patients with cystic fibrosis: Offer long-term oxygen therapy to patients with cystic fibrosis and a resting PaO 55 mmHg (7.3 kPa). B Offer long-term oxygen therapy to patients with cystic fibrosis, a resting PaO 60 mmHg (8 kPa), and either peripheral edema, polycythemia (hematocrit 55%), or evidence of pulmonary hypertension. B Patients with pulmonary hypertension: offer long-term oxygen therapy to patients with pulmonary hypertension (including idiopathic pulmonary hypertension) and a resting PaO 60 mmHg (8 kPa). B Patients with neuromuscular or chest wall disorders: offer noninvasive ventilation as the treatment of choice for patients with hypercapnic respiratory failure due to chest wall or neuromuscular disease. Consider additional long-term oxygen therapy in patients in whom hypoxemia is not corrected with noninvasive ventilation. B Patients with heart failure (long-term oxygen therapy): Offer long-term oxygen therapy to patients with advanced cardiac failure and a resting PaO 55 mmHg (7.3 kPa). B Offer long-term oxygen therapy to patients with advanced cardiac failure, a resting PaO 60 mmHg (8 kPa), and evidence of peripheral edema, polycythemia (hematocrit 55%), or pulmonary hypertension. B https://web.pathway.md/diseases/recnoQqrXqiEQL0qE 3/5 6/24/23, 12:44 PM Home oxygen Pathway Patients with heart failure (nocturnal oxygen therapy): consider offering nocturnal oxygen therapy to patients with severe HF who do not fulfill indications for long-term oxygen therapy, but have evidence of sleep disordered breathing leading to daytime symptoms, after other causes of nocturnal desaturation have been excluded and HF treatment has been optimized. Consider noninvasive ventilatory support in this patient population. C Patients with obstructive sleep apnea: Avoid ordering nocturnal oxygen therapy alone in patients with obstructive sleep apnea, obesity hypoventilation syndrome, or overlap syndrome. D Combine oxygen with noninvasive ventilatory support in patients with evidence of established ventilatory failure in whom oxygen is indicated. B Patients who smoke: Assess the risks of offering long-term oxygen therapy to active smokers on a case-by-case basis, taking into account the patient's attitude toward risks, smoking behavior, and a home visit to assess the patient's home situation. Consider not offering long-term oxygen therapy to patients who continue to smoke if the risks are too high. Give particular consideration to risks to children and risks to neighbors in multiple occupancy dwellings. Avoid prescribing therapy where there is reasonable doubt. 5. Patient education General counseling: arrange for the patient to receive formal education on long-term oxygen therapy by a specialist home oxygen assessment team, in order to ensure compliance with therapy. B Oxygen transport: inform patients that oxygen cylinders should be secured with a seat belt, in the foot-well, or car boot, possibly using a cylinder box, when transported in cars or trucks. Liquid oxygen should always be transported in an upright position. A warning triangle may be displayed and insurance companies should be informed. Safe oxygen use: provide written information on the dangers of using home oxygen within the vicinity of any naked flame, such as pilot lights, cookers, gas fires, and candles. B Show 2 more 6. Follow-up and surveillance Assessment of treatment response: obtain an arterial blood gas after oxygen titration is complete in patients under long-term oxygen therapy, in order to determine whether adequate oxygenation has been achieved without precipitating respiratory acidosis and/or worsening hypercapnia. B Show 3 more Follow-up clinical assessment: schedule follow-up within 4 weeks in patients who develop respiratory acidosis and/or a rise in PaCO of > 7.5 mmHg (> 1 kPa) during assessment for long- https://web.pathway.md/diseases/recnoQqrXqiEQL0qE 4/5 6/24/23, 12:44 PM Home oxygen Pathway term oxygen therapy, as they may have clinically unstable disease. Show 2 more Follow-up home visits: Schedule a home visit within 4 weeks, conducted by a specialist nurse or healthcare professional with experience of domiciliary oxygen therapy, for all patients in whom long-term oxygen therapy is initiated. The visit provides an opportunity to highlight potential risks and should be used to reinforce education and offer support to the patient and carer. Compliance may be checked, along with smoking status, symptoms of hypercapnia and oxygen saturations on oxygen to check that oxygen is therapeutic. Ensure that follow-up visits are conducted by a specialist home oxygen assessment team with the necessary skills to deliver patient education and manage withdrawal of home oxygen. B References 1. Hardinge M, Annandale J, Bourne S et al. British Thoracic Society guidelines for home oxygen use in adults. Thorax. 2015 Jun;70 Suppl 1:i1 43. Open 2. Susan S Jacobs, Jerry A Krishnan, David J Lederer et al. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020 Nov 15;202 10):e121-e141. Open 3. Sagrario Mayoralas Alises, Catia Caneiras, Salvador D az-Lobato. A telephone-based survey of current trends, habits and beliefs in patients receiving portable oxygen therapy in Madrid, Spain. ERJ Open Res. 2019 May 20;5 2 00059 2018. Open https://web.pathway.md/diseases/recnoQqrXqiEQL0qE 5/5