Management of Adult Patients With Oxygen in the Acute Care Setting

Publication Date: November 2, 2021
Last Updated: October 24, 2022


range of 88–92% for patients with COPD who require supplemental oxygen. (C)

The committee recommends an SpO2 range of 94–98% for critically ill patients. (C)

Based on the paucity of literature, there are no recommendations at this time. (N)

The limited available literature and experiences of the committee support early initiation of HFNC vs late initiation of HFNC based on the clinical condition of the patient. (C)

Based on the available evidence and the experience of the committee, HFNC may avoid escalation to NIV and the need for invasive ventilation, likely due to its effects on oxygenation, and dyspnea compared to COT; however, HFNC does not reduce LOS compared to COT. (B)

Compared to COT, HFNC appears to reduce re-intubation when used immediately postextubation. (B)

There appears to be no benefits in LOS, escalation of care, or morbidity of HFNC compared to COT in immunocompromised patients. (B)

The available evidence and the experience of the committee suggest that humidification may be considered for oxygen flows > 4 L/min to improve patient comfort. (C)

Recommendation Grading




Management of Adult Patients With Oxygen in the Acute Care Setting

Authoring Organization

Publication Month/Year

November 2, 2021

Last Updated Month/Year

August 14, 2023

Document Type


Country of Publication


Document Objectives

Providing supplemental oxygen to hospitalized adults is a frequent practice and can be administered via a variety of devices. Oxygen therapy has evolved over the years, and clinicians should follow evidence-based practices to provide maximum benefit and avoid harm. This systematic review and subsequent clinical practice guidelines were developed to answer questions about oxygenation targets, monitoring, early initiation of high-flow oxygen (HFO), benefits of HFO compared to conventional oxygen therapy, and humidification of supplemental oxygen. Using a modification of the RAND/UCLA Appropriateness Method, 7 recommendations were developed to guide the delivery of supplemental oxygen to hospitalized adults: (1) aim for SpO2 range of 94-98% for most hospitalized patients (88-92% for those with COPD), (2) the same SpO2 range of 94-98% for critically ill patients, (3) promote early initiation of HFO, (4) consider HFO to avoid escalation to noninvasive ventilation, (5) consider HFO immediately postextubation to avoid re-intubation, (6) either HFO or conventional oxygen therapy may be used with patients who are immunocompromised, and (7) consider humidification for supplemental oxygen when flows > 4 L/min are used.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Emergency care, Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D010100 - Oxygen


oxygen, acute care, airway

Supplemental Methodology Resources

Data Supplement, Data Supplement