The Effects of Oxygen:

Oxygen, an atmospheric gas, increases saturation of hemoglobin oxygen levels. When used at therapeutic concentrations, it can help oxygenate certain tissues as long at the patient is not in shock or dealing with another complication that could affect the distribution or reception of oxygen.

Oxygen Indications  for Use:

The primary indications for the use of oxygen in ACLS are the presence of:

  • Hypoxemia (an SpO2 less than 94%)
  • Severe respiratory depression
  • Distress (such as asthma, respiratory distress, or depression)

When administering oxygen therapy after the return of spontaneous circulation (otherwise known as ROSC), medical professionals should deliver sufficient oxygenation to maintain an SpO2 that is greater than or equal to 94% (but less than 100%).

Oxygen Precautions & Contraindications:

There are only a few known contraindications for oxygen use in the truly hypoxic patient.  Precautions should be based on new and ongoing research revealing the vasoconstrictive properties that hyperoxia may produce.

If we begin to hyperoxygenate a normoxic cardiac patient, we could be causing lower oxygen absorption and distribution to vital organs that need oxygenation during a coronary crisis.

Adult Dosage for Oxygen:

The appropriate dose of oxygen depends on the needs of the patient and their unique oxygen requirements.  Since oxygen has several different methods for delivery, the percentage of oxygenation is regulated by the flow of oxygen per minute and the delivery adjunct used.

If oxygen delivery by nasal cannula is indicated, it should be delivered  at a rate of 2 to 6 L/min. If a non-rebreather mask is used, the flow rate should be increased to 12 to 15 L/min.  In those patients with respiratory distress/depression, or those who are apneic, oxygenated ventilations should be delivered via a positive pressure device, such as a bag valve mask.

In the case of the respiratory depressed, oxygen flow should be set at 15 L/min. Under current guidelines, oxygen therapy should be titrated to maintain an SpO2 of at least 94% and less than 100%.  A restricted airway will affect the therapeutic response of the oxygenation treatment.

A basic or advanced airway adjunct may be needed in order to open or maintain an open and patent airway.  The patient should be monitored for signs and symptoms along with the electronic and technical monitoring systems.

For example, if the SpO2 reads 92%, but the skin appears normal in the patient, they may have an underlying blood disorder like anemia, which can impede the cyanosis and give an inaccurate appearance of adequate oxygenation.