British chest Society (BTS)
The family oxygen guide provides detailed evidence
Provide basic guidance for discharged patients to use home oxygen.
Although most of the evidence comes from the use of oxygen in patients with chronic pulmonary disease, the scope of guidance includes a variety of patients who use oxygen for a long time
Respiratory diseases and other groups that Currently order oxygen, such as heart failure, cancer, and end-stage patients
Stage heart and lung disease, end-stage disease, or cluster headache.
It explores the evidence base for the use of different oxygen treatments and patients
Related outcomes such as mortality, symptoms and quality of life.
The guidelines also provide evaluation and follow-up advice
Protocol and risk assessment, especially in the clinical challenging areas of oxygen users in the home where smoking is used.
The guideline development team realized that the naming of oxygen in different types of homes at present can sometimes cause confusion and did not rename them, but instead adopted a method to clarify these definitions, especially emphasizing the meaning of long.
Long-term oxygen therapy and palliative oxygen therapy.
Family oxygen guidelines provide expert consensus in areas where clinical evidence is lacking and seek to improve prescription practices, thereby improving compliance and improving patient outcomes, thus increasing the value of health services.
Summary of suggestions and good practices using long-
Effect of long-term oxygen therapy on patients with chronic pulmonary diseaseCOPD)
And rest pa02 ≤ 7.
Should be evaluated for a long period of 3 kPa
Long-term oxygen therapy (LTOT)
Improve the pulmonary blood flow dynamics and improve the survival benefits. (Grade A)
LTOT should be ordered for stable patients with chronic pulmonary obstruction, who have a stationary pa02 ≤ 8 kpa and evidence of peripheral edema and increased red blood cells (
Red blood cell pressure ≥ 55%)
Or high lung pressure(Grade A)
If patients with high CO 2 rest meet all other criteria for LTOT, LTOT should be ordered. (Grade B)
For patients with clearance lung disease, LTOT should be ordered for evidence of other respiratory or cardiac diseases (ILD)
Pa02 ≤ 7 with rest. 3u2005kPa. (Grade D)
For patients with ILD with peripheral edema and multi-cellemia, LTOT (
Red blood cell pressure ≥ 55%)
Or evidence of high blood pressure. (Grade D)
Palliative oxygen therapy can be considered in ILD patients who experience severe dyspnea (POT). (√)
For patients with cystic fibrosis, LTOT should be ordered (CF)
Pa02 ≤ 7 with rest. 3u2005kPa. (Grade D)
In the presence of peripheral edema and multi-cell remia, LTOT should be ordered for CF patients with pa02 ≤ 8 kpa at rest (
Red blood cell pressure ≥ 55%)
Or evidence of high blood pressure. (Grade D)
LTOT in patients with pulmonary hypertension should be ordered for patients with pulmonary hypertension, including patients with pulmonary hypertension, at pa02 ≤ 8kpa kpa. (Grade D)
LTOT in patients with neurological or chest wall disease
Invasive ventilation (NIV)
For patients with chest wall or neuromuscular disease that cause type 2 respiratory failure, it should be the preferred treatment.
Additional LTOT may be required if hypoxia is not corrected with NIV. (Grade D)
LTOT in patients with advanced heart failure should be ordered for patients with advanced heart failure in the stationary period pa02 ≤ 7. 3u2005kPa. (Grade D)
For patients with advanced heart failure with peripheral edema and multi-cellemia, LTOT should be ordered for pa02 ≤ 8 kpa at rest (
Red blood cell pressure ≥ 55%)
Or ECG or ultrasound maps show high pulmonary pressure. (Grade D)
If patients who continue smoking order LTOT, the results of LTOT should discuss with patients the possibility of more limited clinical benefits. (Grade D)
At the time of referral, referral and assessment of LTOTWritten and oral information should be provided to patients referred to the home oxygen assessment service. (Grade D)
Patients with stationary stable oxygen saturation (SpO2)
In order to assess the eligibility of LTOT, reference should be made to the blood gas assessment of ≤ 92%. (Grade C)
Patients with good practice point Ting with clinical evidence of peripheral edema and multi-red blood cell disease (
Red blood cell pressure ≥ 55%)
Or pulmonary high pressure, it may be considered to recommend LTOT assessment in the case of sp02 level ≤ 94% to determine patients with pa02 ≤ 8 kpa at rest. (√)
Referral for oxygen in the discharged patient's home should be formally assessed at least 8 weeks after the last deterioration of LTOT. (Grade B)
Good practice point space with boundary saturation (ie 93–94%)
Their oxygen saturation should be monitored during their annual review with the GP (GP)
Or an internship nurse, or faster if they experience deterioration during this period. (√)
Patients who frequently deteriorate and are unable to achieve a stable period lasting 8 weeks may need to be assessed early after the deterioration.
If LTOT is ordered for these patients, they should be told that LTOT may no longer be needed in the future once they reach a more stable state. (√)
Patients should generally not order LTOT when a potential disease is acute.
However, if domestic oxygen is ordered (
At the time of discharge)
, It should be limited to patients with insufficient breathing and inability to control oxygen with a spo ≤ 92%.
These patients should be subject to a blood gas assessment and are advised that LTOT may not be required in the future after a formal reassessment. (√)
The date of the last deterioration of the patient should be included in the referral request for the home oxygen assessment service. (√)
Pulse oximeters should not be used alone to assess LTOT patients who potentially require ltot to use pulse oximeters, arteries and capillaries in the assessment. (Grade D)
Patients who are being assessed for LTOT should be subject to a preliminary assessment to determine if it is appropriate to use arterial blood gas (ABG)sampling. (Grade A)
Patients who assessed LTOT during the obvious clinical stability period should receive two ABG measurements at least 3 weeks apart before they can confirm the needs of LTOT. (Grade B)
After the completion of the oxygen titration, patients assessed with LTOT should be re-evaluated with ABG to determine if adequate oxygen filling has been achieved without inducing respiratory poisoning and/or(Grade D)
For oxygen titration during LTOT evaluation, capillary blood gas (CBG)
Re-sampling can be done with sampling instead of ABG sampling
PaCO2 and pH were measured at different oxygen flow rates. (Grade A)
For oxygen titration during LTOT assessment, skin CO2 maps can be used for re-measurement instead of ABG sampling
PaCO2 was measured separately, but pH values at different oxygen flow rates were not measured. (Grade A)
Patients with good practice points receiving radial ABG should first be evaluated by Allen's test to ensure that they have a dual blood supply from both radial and ulnar arteries. (√)
Patients receiving radiation ABG should agree to the surgery and discuss possible risks. (√)
Commissioning of home oxygen services in many communities-assessment and review (HOS-AR)
The service was not practical for patients to receive ABG sampling during LTOT assessment.
In this case, the CBGs and the blood oxygen meter (
But not photography.
It can be used as an alternative tool for the initial evaluation of LTOT, after the oxygen titration is completed.
Using this method, some patients may be unnecessarily receptive to LTOT, but it is unlikely that any patient will be improperly rejected. (√)
Management baseline high carbon dioxide during LTOT assessment patients with high carbon dioxide should use ABGs after each flow rate titration to monitor respiratory poisoning and worsening high carbon dioxide, as well as ABG after oxygen titration is completed. (Grade D)
A good practical opinion space for the occurrence of respiratory poisoning and/or elevated PaCO2 (7. 5u2005mmu2005Hg)
During the LTOT assessment, there may be clinically unstable diseases.
These patients should undergo further medical optimization and be re-evaluated after 4 weeks. (√)
Patients with respiratory poisoning and/or increased PaCO2> 1 kpa (7. 5u2005mmu2005Hg)
In two repeated LTOT assessments, although clinically significantly stable, home oxygen should be ordered only at the same time as night ventilation support. (√)
LTOT hours for UseLTOT should be ordered at least 15 hours a day, and a maximum of 24 hours a day may have additional benefits. (Grade C)
Patients with LTOT flow rate that meet LTOT conditions should start at a flow rate of 1 l/min and give an incremental titration of 1 l/min until spo> 90%.
Then, ABG should be performed to confirm that the target P 2 ≥ 8 kpa (60u2005mmu2005Hg)
Rest has been achieved. (Grade B)Non-
In the absence of any taboos, patients with high CO 2 activated by LTOT during sleep should increase the flow rate by 1 l/min. (Grade B)
Patients initiated on LTOT for outdoor activities should undergo a dynamic oxygen assessment to assess whether their flow rate needs to increase during exercise. (Grade B)
Good practice point tests and night-time blood oxygen meters can be performed to order more accurate flow rates for exercise and sleep, respectively. (√)
Patients initiated on LTOT have cognitive, visual, or coordination barriers and may not be able to safely manipulate their own flow rate, which should be maintained at one flow rate. (√)
During the oxygen titration, the flow rate can be increased every 20 minutes until the target co2 is reached. (√)
In evaluating patients with LTOT initiation, patient education should be provided with formal education by a professional home oxygen assessment team to ensure compliance with treatment. (Grade D)
Patients who start using home oxygen at the time of discharge should be informed that if a reassessment shows a clinical improvement, home oxygen may be removed. (Grade D)Follow-
Follow-up of LTOT patients should be followed up
Within 3 months of LTOT being ordered, this should include an assessment of the blood gas and flow rate to ensure that LTOT is still directed and treated. (Grade A)
LTOT patients should be followed up
6-12 months after their first 3 monthsmonth follow-
Up can be combined with both home and hospital visits. (Grade D)Follow-
The expert Home Oxygen assessment team should be followed up with the necessary skills to provide patient education and manage home oxygen withdrawal. (Grade D)
Good practice spires patients who have ordered LTOT should be visited by expert nurses or healthcare professionals with home oxygen treatment experience within 4 weeks.
The visit provides an opportunity to highlight potential risks that should be used to strengthen education and support patients and caregivers.
Compliance can be checked, as well as smoking status, symptoms of high CO 2 and oxygen saturation to check if oxygen has therapeutic effects. (√)
Oxygen therapy at night (NOT)
This is not recommended for patients with chronic lung obstruction who suffer from nocturnal hypoglycemia but do not meet the LTOT criteria. (Grade A)
Good practice has shown that other reasons for the lack of sleep at night in the slow-moving lung should be considered, such as obesity, low ventilation, breathing muscle, or lack of sleep (OSA). (√)
For patients with severe heart failure who do not meet the LTOT indications and have evidence of sleep respiratory disorders, patients with heart disease and nocturnal dessaturation cannot be ordered (SDB)
After excluding other causes of reduced saturation at night, causing daytime symptoms (
Obesity (or OSA)
The treatment of heart failure was optimized.
Treatment with ventilation support should also be considered. (Grade B)
For patients with severe heart failure, do not order good practice points, it should be ordered at a low flow rate of 1-2 µL/min, and the response should be assessed by reducing the symptoms of daytime drowsiness, and the SDB index should be measured by night blood oxygen meter studies
Blood gas assessments should be performed to rule out severe high carbon dioxide and respiratory poisoning.
For patients with high carbon dioxide, treatment using ventilation support mode should be considered. (√)
It should not be taken separately in patients with CFNOT for those who do not meet the LTOT criteria for nocturnal hypoglycemia CF.
Among patients with established evidence of ventilation failure can be considered, in which NIV support should be given. (Grade B)
For patients with ILDNOT, individuals with ILD with nocturnal hypoemia should not be given alone, and they do not meet the LTOT criteria. (Grade B)
Patients with neurological disorders whose muscle weakness affects respiratory muscles should not order separately.
Among patients with established evidence of ventilation failure can be considered, in which NIV support should be given. (Grade B)
There is no OSA, obesity hypoventilation syndrome, or overlap syndrome in patients with OSA, obesity hypoventilation syndrome (OHS)
Or overlapping syndrome should not be ordered separately.
Among patients with established evidence of ventilation failure can be considered, in which NIV support should be given. (Grade D)
Dynamic oxygen therapy should not be routinely provided to patients who are not eligible for LTOT. (Grade B)
AOT should not be routinely provided to patients already on LTOT. (Grade D)
Dynamic oxygen therapy (AOT)
Evaluation should only be provided if patients already on LTOT are moving outdoors. (Grade A)
AOT should be provided to the patient for use during exercise in the pulmonary rehabilitation programme or in the exercise programme after formal evaluation, indicating an improvement in exercise endurance. (Grade B)
Good practice points starting with AOT should be reviewed regularly.
If the AOT is started during the deterioration period or not in due course, it is still essential to conduct a preliminary review in 4-6 weeks to check it. (√)
Home visits may help to identify problems with equipment or equipmentup.
When the condition is stable, a further review should be conducted every 6 months, or if the patient's clinical status changes, it should be reviewed earlier. (√)
AOT treatment can provide patients with a positive lifestyle or a positive treatment plan (eg, CF)
Additional benefits.
All patients should evaluate AOT in the context of daily activities and treatment. (√)
It is recognized that there may be some patients, such as those with ILD and difficulty breathing, who do not qualify for LTOT, but are desaturated during exercise, who may benefit from AOT.
Once all other medical interventions have been optimized, these patients can be considered for AOT after a formal assessment and continue to provide AOT after proof of benefit and compliance. (√)
Patients with high respiratory frequency (
Common in CF and ILD)
AOT should be received at a selected flow rate through the Wenzhong mask, which exceeds their peak moisture and movement aspirated flow and provides home oxygen equipment capable of providing the required high flow rate. (√)
AOT can be provided to LTOT patients, otherwise their daily oxygen use cannot reach 15 hours, or severe hypoxia, severe symptoms, leaving the house without oxygen supplements, but this may be required, such as attending a general practitioner or a hospital appointment.
No formal assessment is required in this case. (√)
Palliative oxygen therapy for cancer or end-stage
If you have a stage of difficult-to-control breathing difficulties, heart and lung disease should not be treated with POT
Hypoxaemic or mild hypoxia levels are higher than the current LTOT threshold (SpO2 ≥92%). (Grade A)
Cancer or end-stage patients
The stage of respiratory disease that goes through difficult-to-control breathing difficulties should be assessed by properly trained health care professionals on an opium treatment trial. (Grade A)
Cancer or end-stage patients
Stage of difficulty-controlled breathing difficulties heart and lung disease should be evaluated by non-therapeutic trials
Drug treatment, including fan treatment from properly trained healthcare professionals. (Grade D)
For patients with stubborn breathing difficulties that do not respond to all other treatments, the expert team sometimes considers good practical views.
In these cases, a separate formal assessment of the impact of palliative oxygen on reducing breathing difficulties and improving quality of life should be conducted. (√)
Treatment of short sudden oxygen (SBOT)
Should not be ordered to be used before or after exercise in low oxygen or regular oxygen patients with chronic lung obstruction. (Grade A)
SBOT should not be ordered when not discharged
Hypoxia in patients with severe chronic lung obstruction. (Grade A)
Using SBOT in a cluster head robot that provides high-flow oxygen therapy (
12 liters/minute pass nonBreathing mask)
Acute attacks for cluster headaches should be provided (CH). (Grade A)
PointAppropriate equipment will need to provide good practices to ensure that the road with high flow rate oxygen 12 µL/min is not usedBreathing mask.
Patients are usually warned of CH attacks, so home oxygen should be installed urgently (if any) instead of providing a permanent home supply. (√)
Equipment for home oxygen therapy oxygen concentrator is applied to deliver LTOT at a flow rate of 4 liters/min or less. (Grade B)
Portable oxygen should be provided through any model that best suits the individual needs of the patient to increase the daily oxygen usage and activity levels of the mobile patient. (Grade C)
A good practical point of view the type of portable device chosen should balance patient factors in terms of cost-effectiveness, resources and safety. (√)
Oxygen delivery nasal catheter should be considered as the preferred delivery device for patients who need home oxygen treatment.
As an alternative, some patients may benefit from the Wenzhu mask system or prefer it. (Grade D)Oxygen-
In home oxygen patients who require a high flow rate, a preservation device can be used to increase the duration of the cylinder. (Grade B)
For those patients with existing or developing high CO2 respiratory failure, high resting breathing rates, or cognitive issues, good practical perspectives should be considered. (√)Oxygen-
After dynamic oxygen assessment, patients with out-of-home activity should consider keeping the device. (√)
You should not order humidifying of household oxygen.
Patient with trachea(Grade D)
Good practice has shown that patients who receive oxygen through the trachea stoma should receive humidified oxygen. (√)
Wheel equipment or backpacks should be provided if the assessment shows that patients carrying home oxygen-free can improve walking and quality of life. (Grade B)
Cylinders should be secured with seat belts or feet during car transportation
It may be the use of the cylinder box, or it may be the car trunk.
Liquid oxygen should always be delivered in an upright position.
A warning triangle may be displayed and the insurance company should be notified. (√)
Before ordering home oxygen, safety and home oxygen treatment for smoking cessation should be discussed and written education should be given to all patients, and if the patient continues to smoke, in each subsequent review. (Grade C)
Patients should be aware in writing of the danger of using home oxygen near any bare flame, such as indicator lights, cookware, gas fires and candles. (Grade D)
Patients and family members who continue to smoke in the presence of home oxygen should be warned of the associated risk of smoking in the presence of oxygen. (Grade D)
When making a decision on the ordering of oxygen, good practice point safety should be a factor.
Education and written information about the safe use of oxygen and its equipment should be provided to patients, family members or carers. (√)
The risk of oxygen prescribed to active smokers should be considered in one caseby-
Case Base: This should include home visits to assess the patient's family situation, attitude towards risk and smoking behavior.
The Home Oxygen assessment service may decide that if the risk of a smoker's judgment is too high, they will not be given home oxygen.
Special consideration needs to be given to the risk of children and the risk of neighbors in multiple residences.
Risk assessment tools should be used and health professionals conducting risk assessments may need to visit the premises with local fire departments and/or oxygen contractors.
Treatment should not be prescribed if there is reasonable doubt. (√)
Patients who continue to smoke or live with other family smokers should be informed that home oxygen orders will be reviewed and evidence of increased risk may result in the withdrawal of home oxygen therapy. (√)
Monitoring and measuring urinary cotinine with carbon monoxide helps identify patients who continue smoking. (√)
Patients should be aware that they should not use email
Cigarettes and Chargers near their home oxygen. (√)Oil-
In the presence of oxygen, the base moisturizer and Vaseline can support combustion.
The patient should know that only water
When using oxygen, the base product is applied to the inside of the hand and face or nose. (√)
If the patient continues to smoke, the oxygen supplier should be notified so that the engineer can consider it in the home oxygen supplier risk assessment. (√)
Patients and family members or carers should be instructed not to remove the fire or change the flow rate on their oxygen equipment.
Only oxygen pipes and connections provided by oxygen companies should be used. (√)
Local fire departments should be made aware of patients who use oxygen at home, especially those who continue to smoke in order to conduct a home safety assessment. (√)
Patients and caregivers should be aware that the pipeline should be checked regularly and relocated as needed to prevent travel and falls and ensure safety. (√)
Evidence of using long-
Effect of long-term oxygen therapy on patients with chronic pulmonary diseaseCOPD)
And rest pa02 ≤ 7.
Should be evaluated for a long period of 3 kPa
Long-term oxygen therapy (LTOT)
Improve the pulmonary blood flow dynamics and improve the survival benefits. (Grade A)
LTOT should be ordered for stable patients with chronic pulmonary obstruction, who have a stationary pa02 ≤ 8 kpa and evidence of peripheral edema and increased red blood cells (
Red blood cell pressure ≥ 55%)
Or high lung pressure(Grade A)
If patients with high CO 2 rest meet all other criteria for LTOT, LTOT should be ordered. (Grade B)
For patients with clearance lung disease, LTOT should be ordered for evidence of other respiratory or cardiac diseases (ILD)
Pa02 ≤ 7 with rest. 3u2005kPa. (Grade D)
For patients with ILD with peripheral edema and multi-cellemia, LTOT (
Red blood cell pressure ≥ 55%)
Or evidence of high blood pressure. (Grade D)
Palliative oxygen therapy can be considered in ILD patients who experience severe dyspnea (POT). (√)
For patients with cystic fibrosis, LTOT should be ordered (CF)
Pa02 ≤ 7 with rest. 3u2005kPa. (Grade D)
In the presence of peripheral edema and multi-cell remia, LTOT should be ordered for CF patients with pa02 ≤ 8 kpa at rest (
Red blood cell pressure ≥ 55%)
Or evidence of high blood pressure. (Grade D)
LTOT in patients with pulmonary hypertension should be ordered for patients with pulmonary hypertension, including patients with pulmonary hypertension, at pa02 ≤ 8kpa kpa. (Grade D)
LTOT in patients with neurological or chest wall disease
Invasive ventilation (NIV)
For patients with chest wall or neuromuscular disease that cause type 2 respiratory failure, it should be the preferred treatment.
Additional LTOT may be required if hypoxia is not corrected with NIV. (Grade D)
LTOT in patients with advanced heart failure should be ordered for patients with advanced heart failure in the stationary period pa02 ≤ 7. 3u2005kPa. (Grade D)
For patients with advanced heart failure with peripheral edema and multi-cellemia, LTOT should be ordered for pa02 ≤ 8 kpa at rest (
Red blood cell pressure ≥ 55%)
Or ECG or ultrasound maps show high pulmonary pressure. (Grade D)
If patients who continue smoking order LTOT, the results of LTOT should discuss with patients the possibility of more limited clinical benefits. (Grade D)
At the time of referral, referral and assessment of LTOTWritten and oral information should be provided to patients referred to the home oxygen assessment service. (Grade D)
Patients with stationary stable oxygen saturation (SpO2)
In order to assess the eligibility of LTOT, reference should be made to the blood gas assessment of ≤ 92%. (Grade C)
Patients with good practice point Ting with clinical evidence of peripheral edema and multi-red blood cell disease (
Red blood cell pressure ≥ 55%)
Or pulmonary high pressure, it may be considered to recommend LTOT assessment in the case of sp02 level ≤ 94% to determine patients with pa02 ≤ 8 kpa at rest. (√)
Referral for oxygen in the discharged patient's home should be formally assessed at least 8 weeks after the last deterioration of LTOT. (Grade B)
Good practice point space with boundary saturation (ie 93–94%)
Their oxygen saturation should be monitored during their annual review with the GP (GP)
Or an internship nurse, or faster if they experience deterioration during this period. (√)
Patients who frequently deteriorate and are unable to achieve a stable period lasting 8 weeks may need to be assessed early after the deterioration.
If LTOT is ordered for these patients, they should be told that LTOT may no longer be needed in the future once they reach a more stable state. (√)
Patients should generally not order LTOT when a potential disease is acute.
However, if domestic oxygen is ordered (
At the time of discharge)
, It should be limited to patients with insufficient breathing and inability to control oxygen with a spo ≤ 92%.
These patients should be subject to a blood gas assessment and are advised that LTOT may not be required in the future after a formal reassessment. (√)
The date of the last deterioration of the patient should be included in the referral request for the home oxygen assessment service. (√)
Pulse oximeters should not be used alone to assess LTOT patients who potentially require ltot to use pulse oximeters, arteries and capillaries in the assessment. (Grade D)
Patients who are being assessed for LTOT should be subject to a preliminary assessment to determine if it is appropriate to use arterial blood gas (ABG)sampling. (Grade A)
Patients who assessed LTOT during the obvious clinical stability period should receive two ABG measurements at least 3 weeks apart before they can confirm the needs of LTOT. (Grade B)
After the completion of the oxygen titration, patients assessed with LTOT should be re-evaluated with ABG to determine if adequate oxygen filling has been achieved without inducing respiratory poisoning and/or(Grade D)
For oxygen titration during LTOT evaluation, capillary blood gas (CBG)
Re-sampling can be done with sampling instead of ABG sampling
PaCO2 and pH were measured at different oxygen flow rates. (Grade A)
For oxygen titration during LTOT assessment, skin CO2 maps can be used for re-measurement instead of ABG sampling
PaCO2 was measured separately, but pH values at different oxygen flow rates were not measured. (Grade A)
Patients with good practice points receiving radial ABG should first be evaluated by Allen's test to ensure that they have a dual blood supply from both radial and ulnar arteries. (√)
Patients receiving radiation ABG should agree to the surgery and discuss possible risks. (√)
Commissioning of home oxygen services in many communities-assessment and review (HOS-AR)
The service was not practical for patients to receive ABG sampling during LTOT assessment.
In this case, the CBGs and the blood oxygen meter (
But not photography.
It can be used as an alternative tool for the initial evaluation of LTOT, after the oxygen titration is completed.
Using this method, some patients may be unnecessarily receptive to LTOT, but it is unlikely that any patient will be improperly rejected. (√)
Management baseline high carbon dioxide during LTOT assessment patients with high carbon dioxide should use ABGs after each flow rate titration to monitor respiratory poisoning and worsening high carbon dioxide, as well as ABG after oxygen titration is completed. (Grade D)
A good practical opinion space for the occurrence of respiratory poisoning and/or elevated PaCO2 (7. 5u2005mmu2005Hg)
During the LTOT assessment, there may be clinically unstable diseases.
These patients should undergo further medical optimization and be re-evaluated after 4 weeks. (√)
Patients with respiratory poisoning and/or increased PaCO2> 1 kpa (7. 5u2005mmu2005Hg)
In two repeated LTOT assessments, although clinically significantly stable, home oxygen should be ordered only at the same time as night ventilation support. (√)
LTOT hours for UseLTOT should be ordered at least 15 hours a day, and a maximum of 24 hours a day may have additional benefits. (Grade C)
Patients with LTOT flow rate that meet LTOT conditions should start at a flow rate of 1 l/min and give an incremental titration of 1 l/min until spo> 90%.
Then, ABG should be performed to confirm that the target P 2 ≥ 8 kpa (60u2005mmu2005Hg)
Rest has been achieved. (Grade B)Non-
In the absence of any taboos, patients with high CO 2 activated by LTOT during sleep should increase the flow rate by 1 l/min. (Grade B)
Patients initiated on LTOT for outdoor activities should undergo a dynamic oxygen assessment to assess whether their flow rate needs to increase during exercise. (Grade B)
Good practice point tests and night-time blood oxygen meters can be performed to order more accurate flow rates for exercise and sleep, respectively. (√)
Patients initiated on LTOT have cognitive, visual, or coordination barriers and may not be able to safely manipulate their own flow rate, which should be maintained at one flow rate. (√)
During the oxygen titration, the flow rate can be increased every 20 minutes until the target co2 is reached. (√)
In evaluating patients with LTOT initiation, patient education should be provided with formal education by a professional home oxygen assessment team to ensure compliance with treatment. (Grade D)
Patients who start using home oxygen at the time of discharge should be informed that if a reassessment shows a clinical improvement, home oxygen may be removed. (Grade D)Follow-
Follow-up of LTOT patients should be followed up
Within 3 months of LTOT being ordered, this should include an assessment of the blood gas and flow rate to ensure that LTOT is still directed and treated. (Grade A)
LTOT patients should be followed up
6-12 months after their first 3 monthsmonth follow-
Up can be combined with both home and hospital visits. (Grade D)Follow-
The expert Home Oxygen assessment team should be followed up with the necessary skills to provide patient education and manage home oxygen withdrawal. (Grade D)
Good practice spires patients who have ordered LTOT should be visited by expert nurses or healthcare professionals with home oxygen treatment experience within 4 weeks.
The visit provides an opportunity to highlight potential risks that should be used to strengthen education and support patients and caregivers.
Compliance can be checked, as well as smoking status, symptoms of high CO 2 and oxygen saturation to check if oxygen has therapeutic effects. (√)
Oxygen therapy at night (NOT)
This is not recommended for patients with chronic lung obstruction who suffer from nocturnal hypoglycemia but do not meet the LTOT criteria. (Grade A)
Good practice has shown that other reasons for the lack of sleep at night in the slow-moving lung should be considered, such as obesity, low ventilation, breathing muscle, or lack of sleep (OSA). (√)
For patients with severe heart failure who do not meet the LTOT indications and have evidence of sleep respiratory disorders, patients with heart disease and nocturnal dessaturation cannot be ordered (SDB)
After excluding other causes of reduced saturation at night, causing daytime symptoms (
Obesity (or OSA)
The treatment of heart failure was optimized.
Treatment with ventilation support should also be considered. (Grade B)
For patients with severe heart failure, do not order good practice points, it should be ordered at a low flow rate of 1-2 µL/min, and the response should be assessed by reducing the symptoms of daytime drowsiness, and the SDB index should be measured by night blood oxygen meter studies
Blood gas assessments should be performed to rule out severe high carbon dioxide and respiratory poisoning.
For patients with high carbon dioxide, treatment using ventilation support mode should be considered. (√)
It should not be taken separately in patients with CFNOT for those who do not meet the LTOT criteria for nocturnal hypoglycemia CF.
Among patients with established evidence of ventilation failure can be considered, in which NIV support should be given. (Grade B)
For patients with ILDNOT, individuals with ILD with nocturnal hypoemia should not be given alone, and they do not meet the LTOT criteria. (Grade B)
Patients with neurological disorders whose muscle weakness affects respiratory muscles should not order separately.
Among patients with established evidence of ventilation failure can be considered, in which NIV support should be given. (Grade B)
There is no OSA, obesity hypoventilation syndrome, or overlap syndrome in patients with OSA, obesity hypoventilation syndrome (OHS)
Or overlapping syndrome should not be ordered separately.
Among patients with established evidence of ventilation failure can be considered, in which NIV support should be given. (Grade D)
Dynamic oxygen therapy should not be routinely provided to patients who are not eligible for LTOT. (Grade B)
AOT should not be routinely provided to patients already on LTOT. (Grade D)
Dynamic oxygen therapy (AOT)
Evaluation should only be provided if patients already on LTOT are moving outdoors. (Grade A)
AOT should be provided to the patient for use during exercise in the pulmonary rehabilitation programme or in the exercise programme after formal evaluation, indicating an improvement in exercise endurance. (Grade B)
Good practice points starting with AOT should be reviewed regularly.
If the AOT is started during the deterioration period or not in due course, it is still essential to conduct a preliminary review in 4-6 weeks to check it. (√)
Home visits may help to identify problems with equipment or equipmentup.
When the condition is stable, a further review should be conducted every 6 months, or if the patient's clinical status changes, it should be reviewed earlier. (√)
AOT treatment can provide patients with a positive lifestyle or a positive treatment plan (eg, CF)
Additional benefits.
All patients should evaluate AOT in the context of daily activities and treatment. (√)
It is recognized that there may be some patients, such as those with ILD and difficulty breathing, who do not qualify for LTOT, but are desaturated during exercise, who may benefit from AOT.
Once all other medical interventions have been optimized, these patients can be considered for AOT after a formal assessment and continue to provide AOT after proof of benefit and compliance. (√)
Patients with high respiratory frequency (
Common in CF and ILD)
AOT should be received at a selected flow rate through the Wenzhong mask, which exceeds their peak moisture and movement aspirated flow and provides home oxygen equipment capable of providing the required high flow rate. (√)
AOT can be provided to LTOT patients, otherwise their daily oxygen use cannot reach 15 hours, or severe hypoxia, severe symptoms, leaving the house without oxygen supplements, but this may be required, such as attending a general practitioner or a hospital appointment.
No formal assessment is required in this case. (√)
Palliative oxygen therapy for cancer or end-stage
If you have a stage of difficult-to-control breathing difficulties, heart and lung disease should not be treated with POT
Hypoxaemic or mild hypoxia levels are higher than the current LTOT threshold (SpO2 ≥92%). (Grade A)
Cancer or end-stage patients
The stage of respiratory disease that goes through difficult-to-control breathing difficulties should be assessed by properly trained health care professionals on an opium treatment trial. (Grade A)
Cancer or end-stage patients
Stage of difficulty-controlled breathing difficulties heart and lung disease should be evaluated by non-therapeutic trials
Drug treatment, including fan treatment from properly trained healthcare professionals. (Grade D)
For patients with stubborn breathing difficulties that do not respond to all other treatments, the expert team sometimes considers good practical views.
In these cases, a separate formal assessment of the impact of palliative oxygen on reducing breathing difficulties and improving quality of life should be conducted. (√)
Treatment of short sudden oxygen (SBOT)
Should not be ordered to be used before or after exercise in low oxygen or regular oxygen patients with chronic lung obstruction. (Grade A)
SBOT should not be ordered when not discharged
Hypoxia in patients with severe chronic lung obstruction. (Grade A)
Using SBOT in a cluster head robot that provides high-flow oxygen therapy (
12 liters/minute pass nonBreathing mask)
Acute attacks for cluster headaches should be provided (CH). (Grade A)
PointAppropriate equipment will need to provide good practices to ensure that the road with high flow rate oxygen 12 µL/min is not usedBreathing mask.
Patients are usually warned of CH attacks, so home oxygen should be installed urgently (if any) instead of providing a permanent home supply. (√)
Equipment for home oxygen therapy oxygen concentrator is applied to deliver LTOT at a flow rate of 4 liters/min or less. (Grade B)
Portable oxygen should be provided through any model that best suits the individual needs of the patient to increase the daily oxygen usage and activity levels of the mobile patient. (Grade C)
A good practical point of view the type of portable device chosen should balance patient factors in terms of cost-effectiveness, resources and safety. (√)
Oxygen delivery nasal catheter should be considered as the preferred delivery device for patients who need home oxygen treatment.
As an alternative, some patients may benefit from the Wenzhu mask system or prefer it. (Grade D)Oxygen-
In home oxygen patients who require a high flow rate, a preservation device can be used to increase the duration of the cylinder. (Grade B)
For those patients with existing or developing high CO2 respiratory failure, high resting breathing rates, or cognitive issues, good practical perspectives should be considered. (√)Oxygen-
After dynamic oxygen assessment, patients with out-of-home activity should consider keeping the device. (√)
You should not order humidifying of household oxygen.
Patient with trachea(Grade D)
Good practice has shown that patients who receive oxygen through the trachea stoma should receive humidified oxygen. (√)
Wheel equipment or backpacks should be provided if the assessment shows that patients carrying home oxygen-free can improve walking and quality of life. (Grade B)
Cylinders should be secured with seat belts or feet during car transportation
It may be the use of the cylinder box, or it may be the car trunk.
Liquid oxygen should always be delivered in an upright position.
A warning triangle may be displayed and the insurance company should be notified. (√)
Before ordering home oxygen, safety and home oxygen treatment for smoking cessation should be discussed and written education should be given to all patients, and if the patient continues to smoke, in each subsequent review. (Grade C)
Patients should be aware in writing of the danger of using home oxygen near any bare flame, such as indicator lights, cookware, gas fires and candles. (Grade D)
Patients and family members who continue to smoke in the presence of home oxygen should be warned of the associated risk of smoking in the presence of oxygen. (Grade D)
When making a decision on the ordering of oxygen, good practice point safety should be a factor.
Education and written information about the safe use of oxygen and its equipment should be provided to patients, family members or carers. (√)
The risk of oxygen prescribed to active smokers should be considered in one caseby-
Case Base: This should include home visits to assess the patient's family situation, attitude towards risk and smoking behavior.
The Home Oxygen assessment service may decide that if the risk of a smoker's judgment is too high, they will not be given home oxygen.
Special consideration needs to be given to the risk of children and the risk of neighbors in multiple residences.
Risk assessment tools should be used and health professionals conducting risk assessments may need to visit the premises with local fire departments and/or oxygen contractors.
Treatment should not be prescribed if there is reasonable doubt. (√)
Patients who continue to smoke or live with other family smokers should be informed that home oxygen orders will be reviewed and evidence of increased risk may result in the withdrawal of home oxygen therapy. (√)
Monitoring and measuring urinary cotinine with carbon monoxide helps identify patients who continue smoking. (√)
Patients should be aware that they should not use email
Cigarettes and Chargers near their home oxygen. (√)Oil-
In the presence of oxygen, the base moisturizer and Vaseline can support combustion.
The patient should know that only water
When using oxygen, the base product is applied to the inside of the hand and face or nose. (√)
If the patient continues to smoke, the oxygen supplier should be notified so that the engineer can consider it in the home oxygen supplier risk assessment. (√)
Patients and family members or carers should be instructed not to remove the fire or change the flow rate on their oxygen equipment.
Only oxygen pipes and connections provided by oxygen companies should be used. (√)
Local fire departments should be made aware of patients who use oxygen at home, especially those who continue to smoke in order to conduct a home safety assessment. (√)
Patients and caregivers should be aware that the pipeline should be checked regularly and relocated as needed to prevent travel and falls and ensure safety. (√)
British chest Society (BTS)
The family oxygen guide provides detailed evidence
Provide basic guidance for discharged patients to use home oxygen.
Although most of the evidence comes from the use of oxygen in patients with chronic pulmonary disease (COPD)
, The scope of guidance includes a variety of patients for a long time
Respiratory diseases and other groups that Currently order oxygen, such as heart failure, cancer, and end-stage patients
Heart and lung disease, end-stage disease and cluster headache (CH).
It explores the evidence base for the use of different oxygen treatments and patients
Related outcomes such as mortality, symptoms and quality of life.
The guidelines also provide evaluation and follow-up advice
Protocol and risk assessment, especially in the clinical challenging areas of oxygen users in the home where smoking is used.
The guideline development team is aware that the naming of oxygen in different types of homes at present can sometimes cause confusion and does not rename them, but rather adopts a method to clarify these definitions, in particular emphasizing the meaning of long
Long-term oxygen therapy (LTOT)
And palliative oxygen therapy (POT).
Family oxygen guidelines provide expert consensus in areas where clinical evidence is lacking and seek to improve prescription practices, thereby improving compliance and improving patient outcomes, thus increasing the value of health services.
Target audience of the guide this guide is for all healthcare practitioners involved in the care of patients with home oxygen therapy: This will include primary care clinicians (
General Practitioner (GPs)
As well as internships and regional nurses)
, Working in community care or palliative care teams, integrated breathing teams, home oxygen assessment services, and hospital expert teams in the areas of respiratory medicine, heart disease, neurology, oncology, gerontology, and palliative care
The panel covering the home oxygen guidelines discussed the use of home oxygen in adults with chronic respiratory diseases, including chronic lung obstruction, pulmonary hypertension, pulmonary vascular disease, cystic fibrosis (CF)
Intermittent lung disease (ILD)
Chest wall disease, neuromuscular disease, and pulmonary malignant heart disease, including heart failure and adult congenital heart disease.
It will also consider special circumstances, including: palliative care and end treatmentof-
Life Care workers wait for a formal assessment after discharge.
The scope guidelines of the guidelines take into account the evidence base and advise on the use or restricted use of the following types of home oxygen therapy: long term
Long-term oxygen therapy (LTOT)
Oxygen therapy at night (NOT)
Dynamic oxygen therapy (AOT)
Palliative oxygen therapy (POT)
Treatment of short explosive oxygen (SBOT).
The guide takes into account the basis of evidence and is recommended, evaluated (
Including blood oxygen meter and arterial blood gas (ABGs)
And bloodshot gas (CBGs)), and follow-
Patients with home oxygen therapy.
The guide reviews the different devices used for home oxygen therapy.
Finally, the guide reviews the safety issues of home oxygen therapy, in particular the risk of inhaling smoke from flammable sources such as fire, Burns and smoking.
It outlines the risk assessment process for the implementation of the national framework agreement on home oxygen therapy (2010)
It outlines the responsibility of the home oxygen provider.
The areas not covered by the guideline development group are aware of the existing BTS guidelines for the relevant areas, so the following areas are not within the scope of this guide: children's home oxygen (Under 18 years of age)—
Oxygen for children's families is still a separate guide.
Household oxygen use during acute aggravation of respiratory diseases
This is covered by the emergency oxygen use BTS guidelines for adult patients.
2 Home Oxygen use during air travel-
For advice on managing passengers with stable respiratory diseases, see the 2011 BTS guidelines.
The guideline development group is not able to cover all disease groups individually, such as branch expansion and asthma.
No evidence of disease-specific use of oxygen was found in these areas.
This guide is based on the best available evidence.
The methodology used to write the guidelines strictly complies with the criteria developed by AGREE collaboration, which is available online (
Care standards of nursing Committee (SOCC)
The guide production manual can be found in questions and literature searches.
Patient, intervention, control, outcome)format (
See Appendix 9 online supplement)
Define the scope of the guidelines and provide information for literature search.
A systematic electronic database search was conducted to identify potential relevant studies for inclusion in the guidelines.
For each subject area, the following database is searched: Ovid MEDLINE (
Limited articles included-Process)
, Ovid EMBASE, and Cochrane Library (
Including the Cochrane System Evaluation database and the effect evaluation summary database)from 1980.
The search was first run on July 2012 and updated on January 2014 (
See Appendix 10 for online supplements for search strategies).
The search includes a combination of index terms and free text terms, limited to English publications.
The initial search identified 1392 potential summaries, and the second search identified 326 summaries.
The assessment of the text assessment is to comply with the agreed cooperation.
4 people (MH, SH, TW, JS)
Read the title and summary of each article retrieved by the literature, and decide whether the paper is absolutely relevant, possibly related to the project.
The criteria developed to divide the summary into these three groups are: whether this study addresses clinical issues;
Whether the appropriate type of study is used to provide the best evidence to answer clinical questions;
Excluding review articles;
The abstract is in English;
According to the publication of the journal, the country in which the study was conducted or published, or the date of publication, the summary was not rejected.
Obtained complete papers of all relevant or possibly relevant abstracts and assigned to the relevant Oxford Health Foundation Trust Home Oxygen assessment services, such as dynamic oxygen assessment based on appendix 1;
The UK patient information leaflet Foundation mentioned in Appendix 6; Barema (
Anaesthetic Association of suppliers of respiratory equipment)
BOC healthcare is used to illustrate photos of household oxygen equipment that are supplemented online in Appendix 12.
Audits and studies recommend investigating which patients with a specific disease phenotype benefit from LTOT: smokers, for example, compared to former smokers
Smokers, people with high lung pressure, people with chronic lung obstruction
Ill and frequent attacks.
Long-term researchterm outcomes (survival)
Diseases, such as CF, ILD, and branch expansion, other than chronic lung obstruction.
The study investigated the delivery of oxygen during the course of lung rehabilitation and maintenance, assessing the impact on outcomes such as deterioration of the condition, exercise tolerance, and quality of life.
Longitudinal LTOT study of the effects of pulmonary blood flow dynamics to evaluate the use of pulmonary hypertension in patients with COPD (
Cardiac catheter insertion)and indirect (eg, NT-
Ultrasound heartbeat map)
Parameters, as well as quality of life and results of exercise tolerance.
A strong assessment of risk assessment measures was undertaken with the aim of developing an integrated pathway for home oxygen teams and Oxygen Provider Services to manage smoking patients.
Studies to study the role of palliative oxygen in comparison to or with other measures such as opium, fan therapy, and cognitive behavior therapy.
The application of ABG and CBG in predicting LTOT demand and high carbon dioxide risk was studied and compared.
Audit of evaluation, ordering and tracking
Family oxygen patients to improve and maintain the standard of care of the family Oxygen assessment team.
View this table: View the inline View popupGlossary/abbreviation and symbol pressure measurement units and use the kPa (kPa)
And Mercury in millimeters (mmu2005Hg)where:1u2005kPa=7.
5mm Hg, 1mm Hg = month. 133u2005kPa.
Target audience of the guide this guide is for all healthcare practitioners involved in the care of patients with home oxygen therapy: This will include primary care clinicians (
General Practitioner (GPs)
As well as internships and regional nurses)
, Working in community care or palliative care teams, integrated breathing teams, home oxygen assessment services, and hospital expert teams in the areas of respiratory medicine, heart disease, neurology, oncology, gerontology, and palliative care
The panel covering the home oxygen guidelines discussed the use of home oxygen in adults with chronic respiratory diseases, including chronic lung obstruction, pulmonary hypertension, pulmonary vascular disease, cystic fibrosis (CF)
Intermittent lung disease (ILD)
Chest wall disease, neuromuscular disease, and pulmonary malignant heart disease, including heart failure and adult congenital heart disease.
It will also consider special circumstances, including: palliative care and end treatmentof-
Life Care workers wait for a formal assessment after discharge.
The scope guidelines of the guidelines take into account the evidence base and advise on the use or restricted use of the following types of home oxygen therapy: long term
Long-term oxygen therapy (LTOT)
Oxygen therapy at night (NOT)
Dynamic oxygen therapy (AOT)
Palliative oxygen therapy (POT)
Treatment of short explosive oxygen (SBOT).
The guide takes into account the basis of evidence and is recommended, evaluated (
Including blood oxygen meter and arterial blood gas (ABGs)
And bloodshot gas (CBGs)), and follow-
Patients with home oxygen therapy.
The guide reviews the different devices used for home oxygen therapy.
Finally, the guide reviews the safety issues of home oxygen therapy, in particular the risk of inhaling smoke from flammable sources such as fire, Burns and smoking.
It outlines the risk assessment process for the implementation of the national framework agreement on home oxygen therapy (2010)
It outlines the responsibility of the home oxygen provider.
The areas not covered by the guideline development group are aware of the existing BTS guidelines for the relevant areas, so the following areas are not within the scope of this guide: children's home oxygen (Under 18 years of age)—
Oxygen for children's families is still a separate guide.
Household oxygen use during acute aggravation of respiratory diseases
This is covered by the emergency oxygen use BTS guidelines for adult patients.
2 Home Oxygen use during air travel-
For advice on managing passengers with stable respiratory diseases, see the 2011 BTS guidelines.
The guideline development group is not able to cover all disease groups individually, such as branch expansion and asthma.
No evidence of disease-specific use of oxygen was found in these areas.
This guide is based on the best available evidence.
The methodology used to write the guidelines strictly complies with the criteria developed by AGREE collaboration, which is available online (
Care standards of nursing Committee (SOCC)
Clinical Issues and literature search guidelines the production manual builds clinical issues in PICO (
Patient, intervention, control, outcome)format (
See Appendix 9 online supplement)
Define the scope of the guidelines and provide information for literature search.
A systematic electronic database search was conducted to identify potential relevant studies for inclusion in the guidelines.
For each subject area, the following database is searched: Ovid MEDLINE (
Limited articles included-Process)
, Ovid EMBASE, and Cochrane Library (
Including the Cochrane System Evaluation database and the effect evaluation summary database)from 1980.
The search was first run on July 2012 and updated on January 2014 (
See Appendix 10 for online supplements for search strategies).
The search includes a combination of index terms and free text terms, limited to English publications.
The initial search identified 1392 potential summaries, and the second search identified 326 summaries.
The assessment of the text assessment is to comply with the agreed cooperation.
4 people (MH, SH, TW, JS)
Read the title and summary of each article retrieved by the literature, and decide whether the paper is absolutely relevant, possibly related to the project.
The criteria developed to divide the summary into these three groups are: whether this study addresses clinical issues;
Whether the appropriate type of study is used to provide the best evidence to answer clinical questions;
Excluding review articles;
The abstract is in English;
According to the publication of the journal, the country in which the study was conducted or published, or the date of publication, the summary was not rejected.
Obtain complete papers of all relevant or possibly relevant summaries and assign them to relevant sections (s)
Guidelines.
The first screening process identified 511 of the initial 1392 reference summaries as positive or likely relevant to the guidelines.
Each section has two Guide reviewers independently reviewing summaries to identify the papers to be evaluated for the guide.
Two reviewers in each section then independently evaluated each paper assigned to them using the Scottish Inter-university guide Network (SIGN)
List of key assessments.
Reliability of evidence in each individual study is graded using the symbol critical assessment checklist and displayed in the evidence sheet (++, + or −)(
See Appendix 11 of the online supplement).
Each suggested body of evidence is summarized as a statement of evidence and graded using a symbolic grading system (see table 1).
View this table: through discussions with Chapter partners, key issues with the presentation of evidence have been addressed.
The second literature search in January 2014 produced 326 abstracts.
56 of them were identified as absolutely or possibly relevant to the guide.
However, the guidelines development team has identified all relevant summaries for this search (GDG)
During this period, it has been established.
GDG uses the evidence sheet to judge the evidence subject and grade recommendation of this guide.
The evidence sheet is provided in Appendix 11 of the online supplement.
If there is a lack of evidence to answer the established clinical questions, expert opinion is obtained by consensus.
The following factors were taken into account in grading the proposal: the number of available evidence bodies;
The applicability of the evidence obtained in making suggestions for a clear target audience of this guide;
Is it possible for the target population of the guideline to generalize this evidence;
Whether there is clear consistency in the evidence obtained in support of the proposal;
In terms of resources and skilled expertise, what is the impact of the recommendation on clinical practice; cost-
No detailed review of effectiveness as follows
An in-depth economic analysis of the proposals is beyond the scope of this guide.
The suggested grades range from A to D, as shown in Table 2, and the strength of the evidence indicates this.
According to the logo guidelines, GDG takes into account evidence rated as "minus" in context, but in the absence of other supporting evidence with a "plus" rating, any suggestions made
As a "point of good practice", it is emphasized that the lack of any research evidence and the future is unlikely to be an important point of practice for research evidence.
View this table: View inline View popuptable 2 recommendation level drafting guide GDG communicate regularly by email, Plenary Group meetings were held on November 2011, February and November 2012, in addition to some conference calls, april and September 2013.
The draft guidelines were reviewed by bts socc in March 2014.
The draft guidelines were published online on July/August 2014 for public consultation and distributed to all relevant stakeholders.
Football League heavy base station
The revised draft guidelines were reviewed in December 2014 and the SOCC final approval was approved in January 2015.
