Oxygen Saturation Targets in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

Introduction to Oxygen Therapy Targets

The British Thoracic Society strongly recommends a target oxygen saturation of 88-92% for all patients with known or at-risk COPD, which should be applied from the initial presentation, before obtaining arterial blood gas results 1, 2
This target range should be maintained even if CO2 levels are normal, as oxygen saturations above 92% are associated with increased mortality 1, 2

The target oxygen saturation range of 88-92% should be applied from the moment of initial presentation, before obtaining arterial blood gas results, to minimize the risk of hypercapnia and hypoxemia 1, 3
The American Thoracic Society and other guideline societies support maintaining this target range for patients with COPD exacerbation, unless there is no history of hypercapnic respiratory failure 2, 3

To initiate controlled oxygen therapy in acute COPD exacerbation, the following devices and flow rates are recommended:
In patients with respiratory rate >30 breaths/min, increase the flow rate of Venturi masks above the specified minimum to compensate for the higher inspiratory flow 2, 3

Arterial blood gas should be obtained at hospital admission and repeated 30-60 minutes after initiating oxygen therapy to assess the need for adjustments in oxygen flow rates 2, 3
If pH and PCO2 are normal, maintain the target oxygen saturation of 88-92% unless there is no history of hypercapnic respiratory failure 2, 3
If PCO2 is elevated but pH ≥7.35, the patient has chronic compensated hypercapnia, and the target oxygen saturation of 88-92% should be strictly maintained 2, 3

Never abruptly discontinue oxygen in hypercapnic patients, as this can cause potentially fatal rebound hypoxemia 2, 3
Avoid excessive oxygen, as this can lead to hypercapnia and increased mortality 2, 3