Oxygen Therapy in Interstitial Lung Disease

Initial Management

• For patients with acute deterioration of interstitial lung disease (ILD), target an oxygen saturation of 94-98%, or the highest possible saturation if these targets cannot be achieved, as recommended by the British Thoracic Society 1, 2
• If SpO2 <85%, start with reservoir mask at 15 L/min, and if SpO2 ≥85%, begin with nasal cannulae at 2-6 L/min or simple face mask at 5-10 L/min 1

Target Oxygen Saturation

• Target range for all ILD patients is 94-98% unless coexisting risk factors for hypercapnia exist, with a strength of evidence supporting this target range 1, 2
• Unlike COPD patients, ILD patients are not typically at risk for hypercapnic respiratory failure and should receive the standard target of 94-98%, according to the British Thoracic Society 3, 4

Oxygen Titration

• Assess initial SpO2 and start oxygen per guidelines, and recheck arterial blood gases if target saturation cannot be maintained with nasal cannulae or simple face mask 1
• Escalate to reservoir mask if lower flow devices fail to achieve 94-98%, and seek senior review immediately if targets remain unachievable despite maximal therapy 1, 3

Common Pitfalls to Avoid

• Do not use the 88-92% target unless the ILD patient has coexisting COPD or documented hypercapnic risk, as recommended by the British Thoracic Society 1, 2
• Avoid hyperoxemia, as unnecessarily high oxygen concentrations (>98%) carry risks of pulmonary toxicity, coronary vasoconstriction, and decreased cardiac output 4, 5