• Clinical science
  • Clinician

Oxygen therapy

Summary

Oxygen therapy is commonly used in hospital settings for the management of acute and chronic respiratory conditions, and increasingly in the community for patients with chronic conditions requiring home oxygen therapy. As with all treatments, oxygen therapy has side effects, and inappropriate use with inadequate monitoring can be fatal. The method of oxygen delivery, monitoring, target oxygen saturation, and indications for weaning should all be tailored to the individual patient. For discharged patients who require long-term oxygen therapy, risks should be discussed with patients and adequate monitoring should be established.

Pathophysiology

To maintain a constant supply of oxygen to the cells, a variety of physiological adaptations respond to hypoxemia and hyperoxemia. [1]

General principles of oxygen delivery

Room air entrainment [2]

  • Definition: the admixture of room air with delivered oxygen due to a negative pressure gradient generated by either the patient or the delivery device itself
  • Consequence: FiO2 does not directly correlate with the oxygen flow rate.
  • Common situations where this may occur:
    • Peak inspiratory flow rate (PIFR) exceeds the flow rate of the oxygen provided (e.g., with low-flow oxygen devices)
    • High flow of oxygen through a small opening with an imperfect seal around the delivery system (e.g., Venturi mask, nonrebreather mask)

Humidified versus nonhumidified oxygen

Nonhumidified oxygen

  • Description: supplied oxygen without added moisture
  • Indications
    • Indefinite use: low-flow (≤ 4/L minute) oxygen via nasal cannula or a mask [3]
    • Conditional use
      • High-flow oxygen (> 4 L/minute) via the upper airways: only for short-term use (up to 24 hours) [1]
      • Any oxygen via tracheostomy or other artificial airways: only in emergencies until humidified oxygen becomes available [1]
  • Advantages
    • More widely available
    • Reduced risk of bacterial contamination [4]
  • Disadvantages
    • May dry out the upper airway mucosa, leading to nose bleeds and discomfort
    • Thickens secretions, leading to difficulty clearing sputum

Humidified oxygen

  • Description: combination of oxygen delivery with a humidification device
  • Indications [1]
  • Advantages
    • Greater patient comfort
    • Does not desiccate mucus membranes
  • Disadvantages
    • Risk of bacterial contamination of humidification devices
    • Less portable

Basic oxygen delivery systems

Oxygen delivery devices and flow rates should always be matched to patients' individual oxygen requirements, which can be varied and dynamic.

Nasal cannula [5]

  • Description: a basic oxygen delivery system consisting of two nasal prongs [5]
  • FiO2 delivered: ∼ 24–40% (1–6 L/minute)
  • Clinical applications: low oxygen saturation in patients who are not critically ill
  • Advantages
    • Well tolerated by patients
    • Allows patients to eat, drink, and speak clearly while remaining on oxygen
  • Disadvantages

Face mask

Simple oxygen face mask [5]

  • Description
    • Plastic face mask covering the nose and mouth that allows for oxygen to enter directly through a port at the bottom of the mask
    • Holes in the side of the mask allow for exhalation (as opposed to one-way valves)
    • No external reservoir bag
  • FiO2 delivered: ∼ 30–60% (5–10 L/minute) [5]
  • Advantages: Less susceptible to room air entrainment than nasal prongs
  • Disadvantages
    • Moderately variable FiO2
    • Cannot be titrated down to < 5 L/minute
    • Prevents normal eating and drinking

Venturi mask

  • Description
  • FiO2 delivered: up to 60%; in increments ranging from 24% to 60% [7]
Overview of venturi systems [8][9]
Color of port Flow rate (L/min) Maximum FiO2 deliverable
Blue 2 24%
White 4 28%
Orange 6 31%
Yellow 8 35%
Red 10 40%
Green 15 60%
  • Advantages
    • Consistent FiO2 delivery
    • Easy to titrate
    • Each port provides a fixed FiO2 concentration, reducing the risk of oxygen-induced hypercapnia.
    • Minimizes rebreathing because of the high flow of gas [7]
  • Disadvantages
    • Noisy and can affect sleep
    • Interrupts normal eating and drinking

Nonrebreather mask (NRB) [5]

  • Description
    • Plastic mask that covers the face and mouth and a reservoir bag that should be prefilled with oxygen
    • One-way valves that prevent rebreathing expired CO2
  • FiO2 delivery: ∼ 60–80% (at flow rates of 10–15 L/minute)
  • Clinical application: first-line treatment for conditions with high oxygen requirements, e.g., critically ill patients
  • Advantages
    • Prevents rebreathing of CO2
    • Rapidly and easily applied in a variety of clinical settings
  • Disadvantages
    • In patients with respiratory distress, FiO2 can vary with breathing as a result of room air entrainment.
    • Cannot be titrated down below 10 L/minute

Nebulizer

  • Description
    • A device that consists of a mask or mouthpiece, a medication reservoir, and tubing that is attached to either an air compressor or oxygen
    • Allows for administration of aerosolized medication (e.g., bronchodilators, racemic epinephrine)
  • Advantages
    • Direct delivery of medication into the lungs and airways
    • Patients can receive oxygen therapy alongside medication.
  • Disadvantages: Oxygen-driven nebulizers are typically limited to flow rates in the range of 6–8 L/minute. [10]

Advanced oxygen delivery systems

Advanced oxygen delivery systems are indicated for patients who remain hypoxic despite treatment with basic oxygen delivery systems, and for patients with tracheostomies.

High-flow nasal cannula (HFNC) [11]

High-flow nasal cannula cannot be replicated by using high flow rates through a basic nasal cannula!

Tracheal delivery systems

Tracheostomy mask

  • Description: oxygen delivery via a small plastic dome that fits over the tracheostomy site [14]
  • FiO2 delivery: 30–80% (8–10 L/minute) [15]
  • Clinical applications: hypoxia in a patient with a tracheostomy who is not mechanically ventilated
  • Advantages
    • More comfortable than a T-piece
    • Easy to apply in emergency settings
  • Disadvantages
    • Moisture can build up on the skin around the tracheostomy site.
    • Variable FiO2 due to the loose fit on the neck

T-piece

  • Description: a T-shaped connection that allows air to flow in from an oxygen supply and exhaled air to exit from the side of the connector
  • FiO2 delivery: 30–80% (8–10 L/minute) [15]
  • Clinical applications
  • Advantages
    • Less moisture collects on the skin around the tracheostomy site than with a tracheostomy collar.
    • Can deliver a higher flow rate than masks
  • Disadvantages
    • Moisture can collect in the tubing, adding to the weight of the tube and causing it to drag on the site. [14]
    • Cumbersome and restricts the patient's movements
    • If the oxygen flow rate is too low, rebreathing will occur. [17]

Transtracheal oxygen therapy (TTOT) [18]

  • Description
    • Transtracheal catheter for patients who require long-term domiciliary oxygen therapy but prefer not to use nasal cannula.
    • Hollow catheter percutaneously inserted into the trachea to deliver long-term low-flow oxygen at rates of 0.5–4 L/minute [19][20]
  • FiO2 delivery: similar to nasal cannula
  • Clinical applications: hypoxemic respiratory failure in preexisting lung disease (e.g., COPD or ILD)
  • Advantages
    • Less nasal irritation compared to long-term nasal cannula use
    • More aesthetically pleasing for patients
    • More efficient, meaning that lower oxygen flow rates can be used [19]
    • Higher compliance than nasal oxygen
  • Disadvantages
    • Can easily become clogged with mucus; patients need to clean their own catheters several times a day
    • Can cause tracheal irritation and granuloma formation
    • Requires an invasive procedure to place it

Assisted ventilation

Short-term oxygen therapy

Indications

Target oxygen saturation range

Target oxygen saturation range
Target saturation Approximate PaO2 [21] Conditions [1][22][23]
100%
  • ≥ 100 mm Hg
94–98% [25]
  • 76–92 mm Hg
90–94% [26]
  • 60–76 mm Hg
88–92%
  • 57–68 mm Hg
85–88%
  • 52–57 mm Hg

General recommendations for starting oxygen [1]

Pulse oximetry [29][30]

  • Technical background
    • Oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb) exhibit different properties of light absorption
      • O2Hb: ↑ infrared light absorption, allows ↑ red light pass through the measurement site (e.g., fingertip)
      • HHb: ↑ red light absorption, allows ↑ infrared light pass through the measurement site
    • An oximeter uses LEDs (light-emitting diodes) emitting both red and infrared light → a photodetector is positioned on the other side of the finger, opposite the LEDs, and detects the amount of light (and whether it is red or infrared light) passing through the measurement site → a processing unit calculates the amount of O2Hb → oximeter displays SpO2
  • Reference range: Resting Oxygen saturation > 95% is generally considered normal.
    • A PaO2 of 100 mm Hg is necessary to reach a SpO2 level of ∼ 98%.
    • Measurement can be inaccurate in patients with: [1]
      • Nail polish
      • Poor perfusion, e.g., severe hypotension
      • Darker skin pigmentation and saturations of < 85%
      • Carbon monoxide exposure, including chronic low-level exposure in smokers
      • Methemoglobinemia [31]
  • Monitoring
    • Should be performed for the majority of patients receiving oxygen therapy
    • Generally accurate to within 1–2 % of true SaO2 until saturations drop to < 80% [1]
    • Patients in whom pulse oximetry is inaccurate and patients at risk of hypercapnic respiratory failure should undergo regular ABGs. [1]

Pulse oximetry provides falsely high values in cases of carbon monoxide poisoning, as complexes of hemoglobin and carbon monoxide are indistinguishable from oxygen-hemoglobin complexes!

Reducing and discontinuing oxygen therapy [1]

  • Weaning
    • Titrate oxygen down if:
      • Saturations are above the target range
      • Saturations have been in the higher end of the target range for 4–8 hours
    • Recheck saturations after 5 minutes at the new oxygen flow rate.
    • Do not discontinue oxygen therapy abruptly if oxygen-induced hypercapnia occurs; this can cause a significant relapse of hypoxemia.
  • Discontinuation criteria
    • The patient is clinically stable on low-flow oxygen.
    • The patient's oxygen saturations have been within the target range on two consecutive observations.
  • Postdiscontinuation monitoring
    • After cessation, saturations should be checked at 5 minutes and then 1 hour.
    • If saturations remain within the target range after 1 hour, the patient can remain off oxygen and return to routine monitoring of vital signs.

Home oxygen therapy

Description

  • Oxygen therapy may be provided on a long-term basis outside of a hospital for patients with chronic conditions.
  • Nasal cannula is the most common method of delivery but alternatives may be used depending on the underlying condition.
  • Home oxygen may be provided via an oxygen concentrator, compressed oxygen cylinders, or liquid oxygen, depending on patient needs and preference.

Indications

Indications for home oxygen therapy
Type of therapy [3] Conditions [32] Recommended parameters [3]
LTOT

Nocturnal oxygen therapy

  • Saturations ≤ 88% on room air when ambulating, exercising, or sleeping, but saturations within target range when alert and at rest
  • Other causes of decreased saturations (e.g., obstructive sleep apnea) have been excluded. [32]
Ambulatory oxygen therapy
Palliative oxygen therapy [1]
  • Any palliative condition
Short-burst oxygen therapy

Long-term oxygen therapy [3]

  • Description
    • The most common form of home oxygen delivery
    • Treatment is typically low flow (1–2 L/minute) oxygen via nasal cannula or TTOT.
    • Typically used in advanced lung disease if patients remain chronically hypoxic despite maximal medical therapy
    • Patients prescribed LTOT should use it for a minimum of 15 hours a day. [34]
  • Monitoring
    • Start at a rate of 1 L/minute; titrate to SpO2> 90% (an ABG should be performed to confirm PaO2 is > 60 mm Hg) [32]
    • If there are signs of worsening hypercapnia, the patient should be assessed for noninvasive home ventilation. [32]
    • Patients prescribed LTOT, nocturnal, or ambulatory oxygen therapy should receive follow-up and monitoring at home after 4 weeks and after 3 months. [32]

Hyperbaric oxygen

Description

  • Definition: intermittent treatment with 100% oxygen delivered at pressures > 1.4 atmospheres [35][36][37]
  • Typical session [38]
    • Duration: 90–120 minutes
    • Frequency: repeated twice daily for up to 30 days

Indications [37]

The use of hyperbaric oxygen treatment in treating autism spectrum disorder, multiple sclerosis, cerebral palsy, and acute stroke is not supported by evidence and should be avoided. [39]

Risks [40]

Complications

The two most significant complications of oxygen therapy are hyperoxemia (with associated oxygen toxicity) and oxygen-induced hypercapnia.

Hyperoxemia and oxygen toxicity [41]

Manifestations of oxygen toxicity
System Effects of hyperoxemia [45]
Cerebrovascular
Cardiovascular
Visual
Respiratory
  • Prevention
    • Patients on oxygen therapy should be monitored with pulse oximetry, and oxygen should be titrated to ensure they remain within their target saturation range.
    • Critically ill patients should receive regular arterial blood gases.

Oxygen-induced hypercapnia [1]

  • Management
    • Gradually titrate oxygen back to 88–92%. [1]
    • Noninvasive ventilation in patients with decompensated hypercapnic respiratory failure who are within target saturations.
  • Prevention
    • Close monitoring for symptoms of hypercapnia.
    • Patients at risk of hypercapnic respiratory failure: ABGs should be performed if drowsiness or other symptoms of hypercapnia develop, if saturations deteriorate, or if acute breathlessness occurs. [1]

Sudden cessation of oxygen therapy in hypercapnic respiratory failure can cause life-threatening rebound hypoxia!

We list the most important complications. The selection is not exhaustive.

  • 1. O’Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017; 72(Suppl 1): pp. ii1–ii90. doi: 10.1136/thoraxjnl-2016-209729.
  • 2. Aitkenhead AR, Thompson J, Rowbotham DJ, Moppett I. Smith and Aitkenhead's Textbook of Anaesthesia E-Book. Elsevier Health Sciences; 2013.
  • 3. AARC. AARC clinical practice guideline. Oxygen therapy in the home or alternate site health care facility--2007 revision & update. Respir Care. 2007; 52(8): pp. 1063–8. pmid: 17715561.
  • 4. Wen Z, Wang W, Zhang H, Wu C, Ding J, Shen M. Is humidified better than non-humidified low-flow oxygen therapy? A systematic review and meta-analysis. J Adv Nurs. 2017; 73(11): pp. 2522–2533. doi: 10.1111/jan.13323.
  • 5. Mosenifar Z, Hoo GWS. Practical Pulmonary and Critical Care Medicine. CRC Press; 2006.
  • 6. Kaminsky D. Netter Collection of Medical Illustrations: Respiratory System E-Book. Elsevier Health Sciences; 2011.
  • 7. Cameron P, Jelinek G, Kelly A-M, Murray L, Brown AFT. Textbook of Adult Emergency Medicine E-Book. Elsevier Health Sciences; 2011.
  • 8. American Heart Association. Advanced Cardiovascular Life Support: Provider Manual. American Heart Association; 2016.
  • 9. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Philadelphia, PA: Elsevier; 2018.
  • 10. Scott HR, Blyth KG, Jones JB. Davidson's Foundations of Clinical Practice E-Book. Elsevier Health Sciences; 2009.
  • 11. Lodeserto FJ, Lettich TM, Rezaie SR. High-flow Nasal Cannula: Mechanisms of Action and Adult and Pediatric Indications. Cureus. 2018; 10(11): p. e3639. doi: 10.7759/cureus.3639.
  • 12. Spicuzza L, Schisano M. High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future. Therapeutic Advances in Chronic Disease. 2020; 11: p. 204062232092010. doi: 10.1177/2040622320920106.
  • 13. Ungerleider RM, Nelson K, Cooper DS, Meliones J, Jacobs J. Critical Heart Disease in Infants and Children E-Book. Elsevier Health Sciences; 2018.
  • 14. Marini JJ, Wheeler AP. Critical Care Medicine. Lippincott Williams & Wilkins; 2010.
  • 15. Smeltzer SC, Bare BG, Cheever KH, Hinkle JL. Textbook of Medical Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins; 2009.
  • 16. Ladeira MT, Ribeiro Vital FM, Andriolo RB, Andriolo BN, Atallah ÁN, Peccin MS. Pressure support versus T-tube for weaning from mechanical ventilation in adults. Cochrane Database Syst Rev. 2014. doi: 10.1002/14651858.cd006056.pub2.
  • 17. Bersten AD, Soni N. Oh's Intensive Care Manual. Elsevier Health Sciences; 2009.
  • 18. Siddiqui FM, Campbell S, Ie S, Biscardi F, Rubio E. Three decades of transtracheal oxygen therapy: A review of the associated complications with an illustrative case presentation. Lung India. 2017; 34(5): pp. 448–451. doi: 10.4103/lungindia.lungindia_33_17.
  • 19. Hardavella G, Karampinis I, Frille A, Sreter K, Rousalova I. Oxygen devices and delivery systems. Breathe. 2019; 15(3): pp. e108–e116. doi: 10.1183/20734735.0204-2019.
  • 20. Volsko TA, Chatburn RL, El-Khatib MF. Equipment for Respiratory Care. Jones & Bartlett Publishers; 2014.
  • 21. Madan A. Correlation between the levels of SpO2 and PaO2. Lung India. 2017; 34(3): pp. 307–308. doi: 10.4103/lungindia.lungindia_106_17.
  • 22. Kaplan JA. Kaplan's Cardiac Anesthesia E-Book. Elsevier Health Sciences; 2016.
  • 23. Nimmagadda U, Salem MR, Crystal GJ. Preoxygenation. Anesth Analg. 2017; 124(2): pp. 507–517. doi: 10.1213/ane.0000000000001589.
  • 24. Mitchell SJ, Bennett MH, et al. Pre hospital management of decompression illness: expert review of key principles and controversies. Diving and Hyperbaric Medicine Journal. 2018; 48(1): pp. 45–55. doi: 10.28920/dhm48.1.45-55.
  • 25. Chu DK, Kim LH-Y, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018; 391(10131): pp. 1693–1705. doi: 10.1016/s0140-6736(18)30479-3.
  • 26. Siemieniuk RAC, Chu DK, Kim LH-Y, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018: p. k4169. doi: 10.1136/bmj.k4169.
  • 27. Fuhrman BP, Zimmerman JJ. Pediatric Critical Care E-Book. Elsevier Health Sciences; 2016.
  • 28. Gawarammana IB, Buckley NA. Medical management of paraquat ingestion. Br J Clin Pharmacol. 2011; 72(5): pp. 745–57. doi: 10.1111/j.1365-2125.2011.04026.x.
  • 29. Chan ED, Chan MM, Chan MM. Pulse oximetry: Understanding its basic principles facilitates appreciation of its limitations. Respir Med. 2013; 107: pp. 789–799. doi: 10.1016/j.rmed.2013.02.004.
  • 30. Jubran A. Pulse oximetry. Crit. Care. 2015; 19(1): p. 272. doi: 10.1186/s13054-015-0984-8.
  • 31. Greenberg MI. Greenberg's Text-atlas of Emergency Medicine. Lippincott Williams & Wilkins; 2005: p. 428.
  • 32. Hardinge M, Annandale J, Bourne S, et al. British Thoracic Society guidelines for home oxygen use in adults: accredited by NICE. Thorax. 2015; 70(Suppl 1): pp. i1–i43. doi: 10.1136/thoraxjnl-2015-206865.
  • 33. McMullin MFF, Mead AJ, Ali S, et al. A guideline for the management of specific situations in polycythaemia vera and secondary erythrocytosis. Br J Haematol. 2018; 184(2): pp. 161–175. doi: 10.1111/bjh.15647.
  • 34. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2020 Report). http://www.goldcopd.org. Accessed June 27, 2019.
  • 35. Bryson PD. Comprehensive Reviews in Toxicology. CRC Press; 1996.
  • 36. Gill AL, Bell CNA. Hyperbaric oxygen: its uses, mechanisms of action and outcomes. QJM. 2004; 97(7): pp. 385–395. doi: 10.1093/qjmed/hch074.
  • 37. Committee UaHMSHO. Hyperbaric Oxygen Therapy Indications: 14th Edition. Undersea and Hyperbaric Medical Society; 2019.
  • 38. Shah J. Hyperbaric Oxygen Therapy. J Am Col Certif Wound Spec. 2010; 2(1): pp. 9–13. doi: 10.1016/j.jcws.2010.04.001.
  • 39. Mathieu, D; Marroni, A; and Kot, J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine Journal. 2017; 47(1). doi: 10.28920/dhm47.1.24-32.
  • 40. Heyboer M, Sharma D, Santiago W, McCulloch N. Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified. Adv Wound Care (New Rochelle). 2017; 6(6): pp. 210–224. doi: 10.1089/wound.2016.0718.
  • 41. Page D, Ablordeppey E, Wessman BT, et al. Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study. Critical Care. 2018; 22(1): p. 9. doi: 10.1186/s13054-017-1926-4.
  • 42. Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P. Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Ann Intensive Care. 2015; 5(1). doi: 10.1186/s13613-015-0084-6.
  • 43. Helmerhorst HJF, Arts DL, Schultz MJ, et al. Metrics of Arterial Hyperoxia and Associated Outcomes in Critical Care*. Crit Care Med. 2017; 45(2): pp. 187–195. doi: 10.1097/ccm.0000000000002084.
  • 44. Six S, Rouzé A, Pouly O, et al. Impact of hyperoxemia on mortality in critically ill patients with ventilator-associated pneumonia. Ann Transl Med. 2018; 6(20): pp. 417–417. doi: 10.21037/atm.2018.10.19.
  • 45. Vincent J-L, Taccone FS, He X. Harmful Effects of Hyperoxia in Postcardiac Arrest, Sepsis, Traumatic Brain Injury, or Stroke: The Importance of Individualized Oxygen Therapy in Critically Ill Patients. Can Respir J. 2017; 2017: pp. 1–7. doi: 10.1155/2017/2834956.
  • 46. Jaffal K, Six S, Zerimech F, Nseir S. Relationship between hyperoxemia and ventilator associated pneumonia. Ann Transl Med. 2017; 5(22): p. 453. doi: 10.21037/atm.2017.10.15.
  • 47. Hasan A. Handbook of Blood Gas/Acid-Base Interpretation. Springer Science & Business Media; 2013.
  • 48. Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012; 16(5): p. 323. doi: 10.1186/cc11475.
  • Mauri T, Wang Y-M, Dalla Corte F, Corcione N, Spinelli E, Pesenti A. Nasal high flow: physiology, efficacy and safety in the acute care setting, a narrative review. Open Access Emergency Medicine. 2019; Volume 11: pp. 109–120. doi: 10.2147/oaem.s180197.
  • Zhao H, Wang H, Sun F, Lyu S, An Y. High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysis. Critical Care. 2017; 21(1): p. 184. doi: 10.1186/s13054-017-1760-8.
  • Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019; 45: pp. 563–572. doi: 10.1007/s00134-019-05590-5.
  • Papazian L, Corley A, Hess D, et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med. 2016; 42(9): pp. 1336–1349. doi: 10.1007/s00134-016-4277-8.
  • Wheeler DS, Wong HR. Pediatric Critical Care Medicine. Springer Science & Business Media; 2007.
  • George RB. Chest Medicine. Lippincott Williams & Wilkins; 2005.
  • Seaton A, Leitch AG, Seaton D. Crofton and Douglas's Respiratory Diseases. John Wiley & Sons; 2008.
  • PK R, Lakshminrusimha S, Vidyasagar D. Essentials of Neonatal Ventilation, 1st edition, E-book. Elsevier Health Sciences; 2018.
  • Fussell KM, Ayo DS, Branca P, Rogers JT, Rodriguez M, Light RW. Assessing need for long-term oxygen therapy: a comparison of conventional evaluation and measures of ambulatory oximetry monitoring. Respir Care. 2003; 48(2): pp. 115–9. pmid: 12556251.
  • Hayes D, Wilson KC, Krivchenia K, et al. Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2019; 199(3): pp. e5–e23. doi: 10.1164/rccm.201812-2276st.
  • Ferreyro BL, Angriman F, Munshi L, et al. Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure. JAMA. 2020. doi: 10.1001/jama.2020.9524.
last updated 09/09/2020
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