Oxygen Supplementation Criteria for COPD Patients

Acute/Emergency Setting Criteria

The British Thoracic Society recommends targeting an oxygen saturation of 88-92% using controlled oxygen delivery, starting with a 24% or 28% Venturi mask, and obtaining arterial blood gas measurements urgently to guide further management in patients with known or suspected COPD 1.
For patients with known COPD or risk factors for hypercapnic respiratory failure, the target saturation should be 88-92% pending blood gas results, according to the British Thoracic Society 1, 2.
The American Thoracic Society suggests starting with 24% Venturi mask at 2-3 L/min or 28% Venturi mask at 4 L/min or nasal cannulae at 1-2 L/min before blood gas results are available in patients with COPD 1, 2.
Titrated oxygen demonstrably reduces mortality compared to high-flow oxygen in acute COPD exacerbations, with one RCT showing a 78% reduction in mortality when oxygen was titrated to maintain saturations between 88-92% versus high-flow oxygen at 8-10 L/min, as reported by the American Heart Association 3, 4.

The American College of Chest Physicians indicates that long-term oxygen therapy is recommended for patients with resting SaO2 ≤88% or PaO2 ≤55 mmHg measured on two occasions at least 3 weeks apart in stable patients 5.
The European Respiratory Society suggests that target oxygen saturation with LTOT should be ≥90% during rest and activity 6.

The European Respiratory Society clearly indicates that supplemental oxygen during exercise training is recommended for patients with severe resting hypoxemia already on LTOT, targeting SpO2 >90% or PaO2 >55 mmHg 6.

The British Thoracic Society warns that excessive oxygen in COPD patients increases the risk of respiratory acidosis, and PaO2 should not exceed 10.0 kPa due to excessive oxygen administration 2.
The American Thoracic Society recommends rechecking blood gases 30-60 minutes after initiating oxygen therapy in patients with COPD or risk factors for hypercapnia, even if initial PCO2 was normal, as hypercapnia can develop acutely 2.