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Use of supplemental oxygen in emergency patients: a systematic review and recommendations for military clinical practice
  1. Laura Cottey1,2,
  2. S Jefferys3,4,
  3. T Woolley5,6 and
  4. J E Smith1,2
  1. 1 Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
  2. 2 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 Emergency Department, Chelsea and Westminster NHS Foundation Trust, London, UK
  4. 4 Army Medical Service, Support Unit, Camberley, UK
  5. 5 Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
  6. 6 Anaesthetic Department, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
  1. Correspondence to Laura Cottey, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK; laurajcottey{at}


Introduction Supplemental oxygen is a key element of emergency treatment algorithms. However, in the operational environment, oxygen supply poses a challenge. The lack of high-quality evidence alongside emerging technologies provides the opportunity to challenge current guidelines. The aim of this review was to appraise the evidence for the administration of oxygen in emergency patients and give recommendations for its use in clinical practice.

Methods A critical review of the literature was undertaken to determine the evidence for emergency supplemental oxygen use.

Results Based on interpretation of the limited available evidence, five key recommendations are made: pulse oximetry should be continuous and initiated as early as possible; oxygen should be available to all trauma and medical patients in the forward operating environment; if peripheral oxygen saturations (SpO2) are greater than or equal to 92%, supplemental oxygen is not routinely required; if SpO2 is less than 92%, supplemental oxygen should be titrated to achieve an SpO2 of greater than 92%; and if flow rates of greater than 5 L/min are required, then urgent evacuation and critical care support should be requested.

Conclusion Oxygen is not universally required for all patients. Current guidelines aim to prevent hypoxia but with potentially conservative limits. Oxygen should be administered to maintain SpO2 at 92% or above. New areas for research, highlighted in this review, may provide a future approach for oxygen use from point of injury to definitive care.

  • oxygen
  • military
  • major trauma
  • emergency medicine
  • anaesthesia

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  • Collaborators Matthew Boyd.

  • Contributors All authors were involved in the conception and design. LC, MB and SJ undertook the search strategy and data extraction. All authors were involved in the analysis, writing and final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.