Regular Article| Volume 95, ISSUE 7, P582-587, July 2001

An evaluation of short-term oxygen therapy: the prescription of oxygen to patients with chronic lung disease hypoxic at discharge from hospital

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      The provision of domiciliary oxygen to patients hypoxic at hospital discharge has been termed short-term oxygen therapy (STOT). This practice appears widespread, although there is a paucity of literature and no evidence-based guidelines.
      We undertook this audit to examine the prescription of STOT and determine the proportion fulfilling for long-term oxygen therapy (LTOT) 2 months post-discharge.
      STOT was defined prospectively: resting P aO2≤7·3 kPa (55 mmHg) or P aO2between 7·3 and 8·0 kPa (60 mmHg) with any of the following: clinical evidence of cor pulmonale (pedal oedema or jugular venous distension), ECG evidence of pulmonale, echocardiogram evidence of pulmonary hypertension, haematocrit>0·55 (adapted directly from LTOT criteria). Patients were evaluated for LTOT 2 months post-discharge when clinically stable on optimal medical management. All referrals to the Auckland Regional Oxygen Service between July 1998 and 1999 were systematically reviewed.
      The majority 289/405 (71%) of new referrals were for the prescription of STOT/LTOT in patients with chronic lung disease: 160/289 (55%) derived from hospitalized patients with the majority 130 (81%) fulfilling criteria for STOT, median age 73, range 24–96 years. Mean hospital stay was 10·2 days. Two months after discharge 22/127 (17%) of STOT patients had died, comparable with 4/22 (18%) not fulfilling criteria for STOT. A total of 123 patients were assessed for LTOT at 2 months; 76 (62%) fulfilled criteria for LTOT.
      The prescription of oxygen at hospital discharge represented a considerable proportion of our referral load. There was a high mortality in the 2-month follow-up period. A significant proportion of STOT patients did not subsequently fulfill criteria for LTOT. Further prospective studies are required in order to develop evidence-based guidelines.




      1. Am Rev Respir Dis. 1990; 142: 721-724
      2. Ann Intern Med. 1980; 93: 391-398
      3. Lancet. 1981; 1: 681-686
      4. Am J Respir Care Med. 1995; 152: S77-S120
        • Tarpy SP
        • Celli BR
        Long-term oxygen therapy.
        NEJM. 1995; 333: 710-714
      5. Thorax. 1997; 52: 1-28
      6. Thoracic Society of Australia and New Zealand, Guidelines for the management of chronic obstructive pulmonary disease position statement, 1998; March 16–19

        • Sivakumaran P
        • Garrett JE
        The prescription of domiciliary long term oxygen therapy in Auckland.
        NZ Med J. 1996; 109: 439-442
        • Carlin BW
        • Clausen JL
        • Reis AL
        The use of cutaneous oximetry in the prescription of long-term oxygen therapy.
        Chest. 1988; 94: 239-241
        • Pierson DJ
        Pulse oximetry versus arterial blood gas specimens in long-term oxygen therapy.
        Lung. 1990; 168: 782-788
        • Restrick LJ
        • Paul EA
        • Braid GM
        • Cullinan P
        • Moore-Gillon J
        • Wedzicha JA
        Assessment and follow-up of patients prescribed long term oxygen treatment.
        Thorax. 1993; 48: 708-713
        • Donohue WJ
        Effect of oxygen therapy on increasing arterial oxygen tension in hypoxemic patients with stable chronic obstructive airways disease while breathing ambient air.
        Chest. 1991; 100: 968-972
        • Levi-Valensi P
        • Weitzenblum E
        • Pendinielli J-L
        Three-month follow-up of arterial blood gas determinations in candidates for long-term oxygen therapy.
        Am Rev Respir Dis. 1986; 133: 547-551
        • Dole R
        • Peter
        • Wheatley K
        • Gray R
        • Sutherland I
        Mortality in relation to smoking: 40 years observations on male British doctors.
        BMJ. 1994; 309: 901-910
        • Poole P
        • Bagg B
        • Brodie SM
        • Blank PN
        Characteristics of patients admitted to hospital with chronic obstructive airways disease.
        NZ Med J. 1997; 110: 272-275
        • Connors Jr, AF
        • Dawson NV
        • Thomas C
        Outcomes following acute exacerbation of severe chronic obstructive lung disease.
        Am J Respir Crit Care Med. 1996; 154: 959-967
        • McCallion J
        • Pearce SJ
        Oxygen concentrators: which patients are being treated and are the DHSS guidelines being followed?.
        Thorax. 1988; 44
      7. Crockett, A, Cranston, J, Moss, J, Alpers, J, The survival of patients with chronic airflow limitation on home oxygen therapy over a 22 year period, 2000, 029

        • Morrison D
        • Skwarski K
        • MacNee
        Review of the prescription of domiciliary long term oxygen therapy in Scotland.
        Thorax. 1995; 50: 1103-1105
        • Roberts CM
        • Franklin J
        • O'Neill A
        Screening patients in general practice with COPD for long term domiciliary oxygen requirement using pulse oximetry.
        Respir Med. 1998; 92: 1265-1268
        • Williams BT
        • Nicholl JP
        Prevalence of hypoxic chronic obstructive lung disease with reference to long term oxygen therapy.
        Lancet. 1985; 2: 369-372
        • Gorecka D
        • Gorzelak K
        • Sliwinski P
        • Tobiasz M
        • Zielinski J
        Effect of long term oxygen on survival in patients with chronic obstructive pulmonary disease with moderate hypoxemia.
        Thorax. 1997; 52: 674-679
        • Heaton RK
        • Grant I
        • McSweeny AJ
        • Adams KM
        • Petty TL
        Psychological effect of continuous oxygen therapy in hypoxic chronic obstructive pulmonary disease.
        Arch Intern Med. 1983; 143: 1941-1947
        • Lahddensuo A
        • Ojanen M
        • Ahonen A
        Psychological effects of continuous oxygen therapy in hypoxemic chronic obstructive pulmonary disease patients.
        Eur Respir J. 1989; 2: 977-980
        • O'Donohue Jr, WJ
        • Plummer AI
        Magnitude of usage and cost of home oxygen therapy in the United States.
        Chest. 1995; 107: 301-302