Indications for supplemental oxygen | | |
Supplemental oxygen should be recommended for fibrotic ILD patients with severe resting hypoxaemia (PaO2 <55 mmHg/SpO2 <89%, or PaO2 <60 mmHg and cor pulmonale and/or polycythaemia) | 5 (0) | 100 |
Supplemental oxygen should be recommended for fibrotic ILD patients with isolated exertional desaturation to <80%, regardless of symptoms | 5 (1) | 74 |
Recommendations for supplemental oxygen use should be consistent across different aetiologies of fibrotic ILD | 4 (0) | 92 |
Supplemental oxygen should be recommended for fibrotic ILD patients with nocturnal hypoxaemia in the absence of other causes such as sleep disordered breathing | 4 (1) | 70 |
Fibrotic ILD patients with isolated exertional hypoxaemia should be advised to use supplemental oxygen during sleep, without the need for nocturnal oximetry testing# | 2 (1) | 83 |
Goals of supplemental oxygen | | |
Supplemental oxygen should be titrated to achieve an oxygen saturation >89% at all times | 4 (1) | 67 |
I recommend supplemental oxygen to improve physical symptoms (e.g. fatigue, decreased energy) in patients with fibrotic ILD and evidence of resting or exertional desaturation | 4 (1) | 83 |
I recommend supplemental oxygen to improve psychological symptoms (e.g. cognition, mood) in patients with fibrotic ILD and evidence of resting or exertional desaturation | 4 (1) | 60 |
I recommend supplemental oxygen to improve dyspnoea in patients with fibrotic ILD and evidence of resting or exertional desaturation | 4 (1) | 84 |
I recommend supplemental oxygen to improve functional capacity in patients with fibrotic ILD and evidence of resting or exertional desaturation | 4 (1) | 86 |
I recommend supplemental oxygen to prevent deconditioning in patients with fibrotic ILD and evidence of resting or exertional desaturation | 4 (1) | 74 |
I recommend supplemental oxygen to improve physiological parameters such as oxygen delivery, cardiac output and arterial oxygen content in patients with fibrotic ILD and evidence of resting or exertional desaturation | 4 (1) | 71 |
Other considerations for supplemental oxygen use | | |
Exertional hypoxaemia should be periodically evaluated by objective standardised testing including but not limited to 6MWT, CPET or shuttle walk in patients with fibrotic ILD | 5 (1) | 88 |
Prior to initiating and continuing supplemental oxygen prescription, the clinician should consider the balance of benefits versus burdens for individual patients with fibrotic ILD | 5 (1) | 93 |
Newer portable oxygen delivery systems should be developed in order to reduce the burden of use in patients with fibrotic ILD | 5 (1) | 100 |
Fibrotic ILD patients with isolated exertional hypoxaemia should undergo a screening test for nocturnal hypoxaemia | 4 (1) | 67 |
Oxygen toxicity is not a concern in most clinical scenarios where supplemental oxygen is prescribed for patients with fibrotic ILD | 4 (1) | 65 |
The development or worsening of exertional desaturation provides evidence of clinical deterioration in patients with fibrotic ILD | 4 (1) | 86 |
Resting hypoxaemia leads to the development of pulmonary hypertension in patients with fibrotic ILD | 4 (1) | 74 |
In patients prescribed supplemental oxygen for isolated exertional hypoxaemia, oxygen should be discontinued in those who do not report any improvement in symptoms or exercise capacity# | 2 (1) | 57 |