NHS leaders quietly asked doctors to lower their targets on the amount of oxygen that critically ill patients should carry in their blood – a measure of basic health – to levels below what is considered “adequate” .
The new guidelines were sent to hospital bosses earlier this month, days after a trust near London declared a critical incident as demand for oxygen from Covid-19 patients caused the pressure to drop. .
Although the NHS England subsequently dispatched engineers across the country to upgrade the piping infrastructure, this has proven to be impossible in many older hospitals.
Officials told trusts on April 9 that to reserve medical gas for those who needed it most, the trusts should lower their oxygen saturation targets.
Low oxygen saturation, known as hypoxia, can lead to organ failure and brain damage.
The normal target saturation range of 94 to 98% should be changed to 92 to 96% “first”, as directed.
The document – which applies to all patients, not just those with Covid-19 – continued: “a target range of 90 to 94 percent can be considered if it is clinically appropriate by hospitals based on demand oxygen flow rates. “
The permanent protocols of the British Thoracic Society (BTS) state that patients with acute illness should have oxygen saturation greater than 90%.
BTS President-elect Dr. Graham Burns said that while 90% is not necessarily dangerous, the goal of the traditional 94% threshold was to provide “room for maneuver”.
“It is not ideal,” he said.
“90% is when you start to approach the cliff, so we prefer 94% because it’s a step away from that. “
“Where hospitals are lucky enough to provide adequate flow, a higher level would be preferable.”
He said some NHS hospitals have already adopted the new targets where demand from Covid patients has pushed oxygen delivery systems to their limits.
Dr. Nick Scriven, President of the Society for Acute Medicine, said that 90% oxygen saturation may be acceptable for critically ill patients once they have stabilized.
But he added, “If you go through the door urgently, we should try to get you to 94.”
Invited by the epidemics in Wuhan and northern Italy, British planners have focused intensely on increasing the number of intensive care beds and accompanying mechanical ventilators.