Patient safety

New Guidelines for Oxygen Therapy Treatment

Although oxygen use has been a staple in medical practice for decades, new recommendations suggest limited use in certain patient populations, according to a new Rapid Recommendation published by the BMJ.


“A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital,” the authors wrote.


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Published as part of the BMJ’s “Rapid Recommendations” series, the new recommendations were created by a panel of international experts using the GRADE framework.


The research questions asked during creation of these recommendations were:

  • In acutely ill patients, when should oxygen therapy be started? (What is the lower limit of SpO2?)
  • In acutely ill patients receiving oxygen therapy, how much oxygen should be given? (What is the upper limit of SpO2?)


The 3 main recommendations include:

  1. Acutely ill adult medical patients (with exceptions) should stop oxygen therapy no higher than 96% saturation. (strong recommendation)
  2. Patients with acute stroke or MI should not start oxygen therapy between 90% and 92% saturation. (weak recommendation)
  3. Patients with acute stroke or MI should not start oxygen therapy at or above 93% saturation. (strong recommendation)


“The ideal oxygen saturation at which to start oxygen therapy is uncertain, but is likely below 93%,” the authors wrote.


The panel did not make a recommendation for when to start (the lower limit) oxygen for all medical patients, because there was not enough evidence.


—Colleen Murphy



Siemieniuk RAC, Chu DK, L HY Kim, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169.