Patient Requires Oxygen Assessment
Hypoxia suspected or confirmed
All Pathways
Pulmonary MedicineManagement
Oxygen Therapy in Acute Illness (BTS 2017)
Oxygen Therapy in Acute Illness (BTS 2017): Patient Requires Oxygen Assessment → Initial Assessment → At Risk of Hypercapnia? → Standard Target: 94-98% ...
Pathway Overview
15 steps
Algorithm Steps
15 total
01Start 02Action Initial Assessment
Check SpO2 on room air
- Pulse oximetry (SpO2)
- Respiratory rate and pattern
- Work of breathing
- Mental status
- ABG if hypercapnia risk
03Decision At Risk of Hypercapnia?
Identify CO2 retainers
- Known COPD
- Severe obesity (BMI >40)
- Neuromuscular disease
- Chest wall deformity
- Bronchiectasis
- Previous hypercapnic respiratory failure
04Action Standard Target: 94-98%
For most acutely ill patients
- Target SpO2 94-98%
- Start with appropriate device
- Titrate to maintain target
- Do not exceed target unnecessarily
05Decision Select Oxygen Device
Based on oxygen requirement
- Nasal cannula: 1-6 L/min (24-44%)
- Simple face mask: 5-10 L/min (40-60%)
- Non-rebreather mask: 10-15 L/min (60-90%)
- High-flow nasal cannula if available
06Action Nasal Cannula
For mild hypoxia
- 1-6 L/min flow rate
- Approximate FiO2: 24-44%
- Comfortable for prolonged use
- Can eat/drink/talk
07Action Monitor Response
Titrate to target
- Continuous SpO2 monitoring
- Adjust flow to maintain target
- Reduce O2 if above target
- ABG if not improving or hypercapnia risk
- Document target range on prescription
08Warning ⚠️ Escalate Care
If not responding to high-flow O2
- Consider high-flow nasal cannula (HFNC)
- Consider NIV/CPAP
- ICU referral if deteriorating
- Review diagnosis
09Action Stable on Target
Continue current therapy
- Document oxygen prescription
- Regular SpO2 monitoring
- Wean O2 as condition improves
- Consider cause of hypoxia
10Outcome Wean Oxygen
When clinically improving
- Reduce flow rate gradually
- Maintain SpO2 within target
- Trial on room air if SpO2 stable on low-flow
- Document SpO2 on room air before discharge
11Action Simple Face Mask
Moderate oxygen needs
- 5-10 L/min (minimum 5L)
- FiO2 approximately 40-60%
- Higher flow = higher FiO2
- Path rejoins step 07Shared downstream outcome
12Action Non-Rebreather Mask
Severe hypoxia
- 10-15 L/min
- FiO2 60-90%
- Reservoir must stay inflated
- For critical hypoxia
- Path rejoins step 07Shared downstream outcome
13Action Controlled O2: 88-92%
For hypercapnia risk patients
- Target SpO2 88-92% initially
- Use Venturi mask 24-28% to start
- Check ABG within 30-60 min
- Adjust target based on ABG
- May increase to 94-98% if pH normal
14Action Venturi Mask
Controlled FiO2 delivery
- 24%, 28%, 31%, 35%, 40%, 60% options
- Color-coded valves
- Use specified flow rate on valve
- Preferred for hypercapnia risk
15Decision Check ABG
For hypercapnia risk patients
- pH <7.35 with high CO2 = respiratory acidosis
- May need NIV if acidotic
- Adjust target if CO2 normal
- Path rejoins step 07Shared downstream outcome
Guideline Source
BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Targets may need adjustment for specific conditions
- Does not cover neonatal oxygen therapy
- Palliative care patients may have different targets
- High-flow oxygen devices not fully covered in 2017 guideline
Contraindicated Populations
neonates
Applicable Regions
UKGlobal
Global: Principles applicable globally; device availability varies
Version 1Next review: 2027-01-01
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Related Resources
Frequently Asked Questions
What is the Oxygen Therapy in Acute Illness (BTS 2017)?
The Oxygen Therapy in Acute Illness (BTS 2017) is a management clinical algorithm for Pulmonary Medicine. It provides a structured decision tree to guide clinical decision-making, based on BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings.
What guideline is the Oxygen Therapy in Acute Illness (BTS 2017) based on?
This algorithm is based on BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings (DOI: 10.1136/thoraxjnl-2016-209729).
What are the limitations of the Oxygen Therapy in Acute Illness (BTS 2017)?
Known limitations include: Targets may need adjustment for specific conditions; Does not cover neonatal oxygen therapy; Palliative care patients may have different targets; High-flow oxygen devices not fully covered in 2017 guideline. Individual patient factors may require deviation from these recommendations.
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