Algorithm B3: Oxygen Therapy

Inpatient with COPD exacerbation and SaO2 less than or equal to 90 percent
Using oximetry, titrate O2 by Venturi mask or nasal cannula (24% to 35%) to SaO2 of 90% [A]
Obtain ABGs [B]
Is pCO2 greater than or equal to 45? Is pH less than or equal to 7.25? Does patient need mechanical ventilation? [C] Initiate ventilation
Box 4 no to box 16 Is PaO2 less than or equal to 60? Box 6 no to box 9 and box 11 yes to box 12 Admit to ICU
Box 11 no to box 15 Stepwise increase in FiO2 [D] Monitor clinically by ABGs and pulse oximetry
Decrease FiO2 progressively keeping PaO2 greater than or equal to 60 or SaO2 equal to 90 percent AND monitor with oximetry and ABGs [F] Are ABGs acceptable? [E] Box 9 to box ten and box 13 yes to box 10
Go to box 4
Maintain oxygen saturation at 90% (pO2 between 55 and 60 mmHg). Titrate to the lowest possible FiO2 to achieve this goal. In the absence of elevation PCO2 or other acid-base abnormalities, pulse oximetry may be used [D] Maintain oxygen saturation at 90% (pO2 between 55 and 60 mmHg). Titrate to the lowest possible FiO2 to achieve this goal. In the absence of elevation PCO2 or other acid-base abnormalities, pulse oximetry may be used [F] Box 16 to box 10 Continue inpatient management. Return to Module B1 Box 8