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THE SCOPE OF THIS CLINICAL BEST PRACTICE GUIDELINE (CBPG)

Evidence-Based Practice

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“Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients/clients. The practice of evidence-based medicine means integrating individual clinical expertise and experience with the best available clinically relevant evidence from systematic research” (Sackett et al., 1996).

There is a vast amount of evidence-based, clinical information that is readily available on the Internet, and this information is constantly changing. This CBPG is not intended to be an all-inclusive oxygen therapy manual or textbook.  Rather, this  CBPG has been designed for use online and provides links to resources that can be used by RTs (and other users) to pursue their learning and professional development regarding best practices for oxygen therapy.

Specific recommendations for the delivery of oxygen via mechanical ventilation (invasive and non-invasive) and other complex respiratory care devices is beyond the scope of this CBPG.

This CBPG will not attempt to discuss the specific use of oxygen or prescribe target oxygen saturations for the treatment of different pathophysiological presentations (e.g., COPD). Alternatively, links to additional evidence-based, clinical best practice guidelines will be provided wherever possible (e.g., Canadian Thoracic Society’s COPD Guidelines).

This CBPG is informed by the most current evidenced-based materials that were available at the time of publication. For example, the British Thoracic Society: Oxygen and the Canadian Thoracic Society’s documents. The CRTO is committed to maintaining up-to-date and accurate information to the best of its abilities and welcomes input regarding the best practices for oxygen therapy on an on-going basis.

GLOSSARY

(ATP) Ambient Temperature and Pressure = (STP) standard temperature and pressure = 0C and 1 atmosphere

BTPS = Body Temperature and ambient Pressure Saturated = 37 °C, 1 atmosphere, and 44 mg H2O/L

Conserving Devices - How long liquid and cylinder systems last before refilling depends on the amount of oxygen a person uses. Conserving devices extend the length of time. Oxygen systems deliver oxygen continuously during inspiration and exhalation. Conserving devices can be programmed to deliver oxygen during inspiration only, therefore reducing the amount wasted during exhalation.

Cryogenic Vessel - A static or mobile vacuum insulated container designed to contain liquefied gas at extremely low temperatures. Mobile vessels could also be known as "Dewars". Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-health-products/compliance-enforcement/good-manufacturing-practices/guidance-documents/gmp-guidelines-0031/document.html

Drug Identification Number (DIN) - a computer-generated eight-digit number assigned by Health Canada to a drug product prior to being marketed in Canada. It uniquely identifies all drug products sold in a dosage form in Canada and is located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada. A DIN uniquely identifies the following product characteristics: manufacturer; product name; active ingredient(s); strength(s) of active ingredient(s); pharmaceutical form; route of administration. Retrieved from: www.hc-sc.gc.ca/dhp-mps/prodpharma/activit/fs-fi/dinfs_fd-eng.php

Fractional Distillation - the process of separating the portions of a mixture by heating it and condensing the components according to their different boiling points. Retreived from: http://medical-dictionary.thefreedictionary.com/fractional+distillation

Medical gas - (either a single gas or a mixture of gases) is a gas that requires no further processing in order to be administered, but is not in its final package (e.g., liquefied oxygen) and is known as a bulk gas. Retrieved from: http://ccinfoweb2.ccohs.ca/legislation/documents/stds/csa/cmgpi12e.htm

Manifold (rampe) - Equipment or apparatus designed to enable one or more medical gas containers to be filled at a time.

REFERENCES

  1. American Thoracic Society (2020) Clinical Practice Guideline: Home Oxygen Therapy for Adults with Chronic Lung Disease.  Retrieved from: https://www.atsjournals.org/doi/pdf/10.1164/rccm.202009-3608ST
  2. Becker, D. E., & Casabianca, A. B. (2009). Respiratory monitoring: physiological and technical considerations. Anesthesia Progress, 56(1), 14-20. doi: 10.2344/0003-3006-56.1.14.
  3. Cairo, J., M. & Pilbeam, S., P., (2017) Mosby’s Respiratory Care Equipment (10th ed.). St. Louis, MO: Mosby.
  4. Canadian Standards Association. (2016). Z305.12-06 (R2012) - Safe Storage, Handling, and Use of Portable Oxygen Systems in Residential Buildings and Health Care Facilities. Retrieved from: https://www.csagroup.org/store/search-results/?search=all~~Safe%20Storage,%20Handling,%20and%20Use%20of%20Portable%20Oxygen%20Systems%20in%20Residential%20Buildings%20and%20Health%20Care
  5. Cousins JL, Wark PA, McDonald VM. Acute oxygen therapy: a review of prescribing and delivery practices. Int J Chron Obstruct Pulmon Dis. 2016;11:1067-1075. Published 2016 May 24. doi:10.2147/COPD.S103607
  6. Gardenshire, D. (2020). Rau’s Respiratory Care Pharmacology. (10th ed.). St. Louis, MO: Mosby Inc.
  7. Kacmarek, R. M., Stoller, J.K. Heuer, A. J. (2021). Egan’s Fundamentals of Respiratory Care. (12th ed.). St. Louis, MO: Mosby.
  8. Mariciniuk, D. D., Goodridge, D., Hemandez, P., Rocker, J., Balter, M., Bailey, P., Brown, C. (2011). Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: A Canadian Thoracic Society clinical practice guideline. Canadian Respiratory Journal, 18(2), 69–78. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC3084418/
  9. Ministry of Health and Long-Term Care. Policy and Procedures Manual for the Assistive Devices Program (May 2016). Conflict of Interest. Retrieved from: Policies and Procedures Manual of the Assistive Devices Program (gov.on.ca)
  10. O'Driscoll, B. R., Howard, L. S., Earis, J., & Mak, V. (2017). British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings. BMJ open respiratory research, 4(1), e000170. Retrieved from: https://doi.org/10.1136/bmjresp-2016-000170
  11. Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence-based medicine: what it is and what it isn't. British Medical Journal, 312, 71-72. Retrieved from: www.bmj.com/cgi/content/full/312/7023/71