To identify if oxygen therapy is maintaining the target saturation or if an increase or decrease in oxygen therapy is required F7. In pleural effusion, aim at an oxygen saturation of 94–98% (or 88–92% if the patient is at risk of hypercapnic respiratory failure) (grade D). Oxygen is a treatment for hypoxaemia, not breathlessness. Oxygen has not been proven to have any consistent effect on the sensation of breathlessness in non-hypoxaemic patients.

Royal Pharmaceutical Society of Great Britain (2005) British National Formulary for Children. London, BMJ Publishing House Ltd Calculate the P/F ratio instead of the old-fashioned way of calculating an adequate PaO 2 for a patient on supplemental oxygen (subtracting 10 from the FiO 2). For every increase in 1L/min, the fraction of inspired oxygen (FiO 2) increases by 4% (e.g. 1L/min = 24% FiO 2, 2L/min = 28% FiO 2 etc). The target saturation should be written (or ringed) on the drug chart or entered in an electronic prescribing system (guidance on figure 1).There are relevant places on drug charts to do this, usually defined with two options: 88-92% or >94%

Role of presently available antifibrotic drugs (pirfenidone and nintedanib) needs further research in the present pandemic. There is no evidence that antifibrotic therapies (nintedanib and pirfenidone) impact the risk or severity of COVID-19. All COVID-19 patients admitted to the hospital should be given prophylactic dose of heparin unless contraindicated. An NPSA rapid response report ‘Oxygen safety in hospitals’ in 2009 reported 281 serious incidents from Dec 2004 to June 2009 relating to oxygen therapy and that poor oxygen management caused 9 deaths and contributed to a further 35. This report placed an obligation on hospitals to introduce measures to reduce avoidable harm associated with administration of oxygen. Patients with a definite diagnosis of hyperventilation should have their oxygen saturation monitored. Those with normal or high SpO 2 do not require oxygen therapy.If oxygen needs to be prescribed, you should also take a systematic approach to identify why the patient has desaturated. Always involve a senior clinician if you are concerned or unsure how to manage the patient. For example, 15 L/min of oxygen at a FiO2 of 100% and 15 L/min of air at a FiO2 of 21% to give a total of 30 L/min of flow at a diluted FiO2 of 60%. Or perhaps 15 L/min of oxygen at a FiO2 of 100% and 30 L/min of air at a FiO2 of 21% to give a total of 45 L/min of flow at a diluted FiO2 of 47%. The world is your oyster!Devices such as the AIRVO 2, do all of the above calculations for you. All you need to do is dial-up how much total flow you want to set for your patient and increase the oxygen flow meter to achieve the desired FiO2 to maintain adequate oxygen saturation. B4. For patients who are at risk of hypercapnic respiratory failure, it is recommended that the relevant section of the 2017 NEWS chart should be used. Points are awarded if the oxygen saturation is below or above the target range (grade D). When conventional delivery methods are not tolerated, wafting of oxygen via a face mask has been shown to deliver concentrations of 30% - 40% with 10 litres oxygen per minute, to an area of 35 x 32cms from top of the mask. Wafting via green oxygen tubing has been assessed as appropriate for short- term use only, i.e., whilst feeding. A standard paediatric oxygen mask placed on the chest can give significant oxygen therapy with minimal distress to the patient (11). Monitor the patient’s oxygen saturations for 5 minutes without supplemental oxygen. If they remain within their target saturations, measure their oxygen saturations in 1 hour (and then use clinical judgment regarding when you will measure them again). 2