Home Oxygen Therapy Guidelines

Indications for Home Oxygen Therapy

Home oxygen therapy is primarily indicated for patients with chronic hypoxemia, specifically those with a resting PaO2 ≤7.3 kPa (55 mmHg) or SpO2 ≤88%, as well as those with PaO2 ≤8 kPa (60 mmHg) who have evidence of end-organ damage, as recommended by the British Thoracic Society and the American Thoracic Society 1, 2
Patients with severe resting hypoxemia (PaO2 ≤7.3 kPa or SpO2 ≤88%) and moderate hypoxemia (PaO2 ≤8 kPa with evidence of end-organ damage) are eligible for home oxygen therapy, according to the European Respiratory Society and supported by the American College of Physicians 1, 3
Mild chronic hypoxemia with dyspnea on exertion or desaturation during sleep or exertion may also benefit from home oxygen therapy, as recommended by the American Thoracic Society 1
Severe chronic hypoxemia is an indication for home oxygen therapy, according to the American Thoracic Society 2
Patients with congenital heart disease require consultation with a pediatric pulmonologist or cardiologist before initiating home oxygen therapy, as recommended by the American Thoracic Society 2

For pediatric patients, a low SpO2 for a duration of 2 weeks is sufficient evidence for chronic hypoxemia if clinically stable, as recommended by the American Thoracic Society 2
Diagnosis is confirmed by arterial blood gas measurement in a stable clinical condition, with a second measurement after 3 weeks of stability, and evaluation of oxygen saturation during exercise, as recommended by the American Thoracic Society and the European Respiratory Society 3, 4, 5

The minimum duration of LTOT is 15 hours per day, including sleep periods, with a typical flow rate of 1.5-2.5 L/min via nasal cannula, as recommended by the European Respiratory Society 4
Annual reassessment of flow rates is recommended, as stated by the European Respiratory Society 4
Continuous administration of LTOT has been shown to have a greater survival benefit than intermittent administration, according to the European Respiratory Society 4, 6

Home oxygen therapy is used in end-stage cardiorespiratory disease and terminal illness to alleviate severe breathlessness, as recommended by the British Thoracic Society 1
For patients with interstitial lung disease (ILD) or other conditions experiencing severe breathlessness, home oxygen therapy may be beneficial 1
Current smoking is a contraindication for LTOT due to fire hazard and safety concerns, as recommended by the European Respiratory Society and the American Thoracic Society 4, 7
Hypercapnia risk should be assessed, and excessive oxygen administration should be avoided, as recommended by the European Respiratory Society 4

Water-based products should be used on hands and face while using oxygen to minimize fire hazard, as advised by the British Thoracic Society 1
Local fire service should be informed about patients using home oxygen to ensure safety precautions are in place 1
Monitoring for acidemia is recommended, and non-invasive or invasive mechanical ventilation should be considered if acidemia occurs, as recommended by the European Respiratory Society 8

Improved pulmonary hemodynamics is a benefit of home oxygen therapy, as reported by the British Thoracic Society 1
LTOT may improve quality of life, reduce hospitalizations, and decrease risk of comorbidities in appropriately selected patients, according to the European Respiratory Society 9
The goal of LTOT is to maintain an SaO2 >90% without worsening respiratory acidosis, as recommended by the European Respiratory Society and the American College of Chest Physicians 8, 3

Nasal cannulae are the most commonly used equipment for LTOT, as recommended by the European Respiratory Society 4
Venturi masks provide more accurate oxygen concentration, as recommended by the European Respiratory Society 4
Transtracheal oxygen is an option for patients with high oxygen demands or cosmetic concerns, as recommended by the European Respiratory Society 4
Oxygen concentrators are the easiest option for home use, while liquid oxygen has the advantage of portable systems for travel and exercise, and cylinders are less practical for LTOT due to bulk and cost, as recommended by the European Respiratory Society 4