BTS guidelines for home oxygen in children. BTS guideline for oxygen use in adults in healthcare and emergency settings BRO’Driscoll,1,2 L S Howard,3 J Earis,4 V Mak,5 on behalf of the British Thoracic Society Emergency Oxygen Guideline Group Additional material is published online only. Although the majority of evidence comes from the use of oxygen in patients with chronic obstructive pulmonary disease, the scope of the guidance … The subjects were then given supplemental oxygen; 24% oxygen by Venturi mask increased Pa o 2 to 8.02 kPa, 28% oxygen by Venturi mask increased Pa o 2 to 8.55 kPa, and 4 l/min via nasal prongs increased Pa o 2 to 10.79 kPa. BTS guideline for oxygen use in adults in healthcare and emergency settings Thorax. Clinical guidelines have been shown to improve Otherwise, the cylinder must be fitted with a high-flow regulator capable of delivering a flow of up to 15 l/min in order to deliver medium-concentration and high-concentration oxygen therapy. 2017-11-07T10:03:00. Thorax 2017; 72: i1–i90. The 2017 guidance is based on new evidence about how effective prescribing and delivery of emergency oxygen for patients can improve health and saved lives. 17 Doughty St, Oxygen. They include the most recent evidence from the British Thoracic Society (BTS) which serve to: Promote best practice. Critical illness requiring high levels of supplemental oxygen: shock, sepsis, major trauma, drowning, anaphylaxis, major pulmonary haemorrhage, status epilepticus. oxygen must not be used near a naked flame or source of heat. WC1N 2PL. British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings.pdf Available via license: CC BY-NC 4.0 Content may be subject to copyright. 1. Oxygen is one of the most widely used drugs, and is used across the whole range of health care specialties. The British Thoracic Society (BTS) Home Oxygen Guideline provides detailed evidence-based guidance for the use of home oxygen for patients out of hospital. bronchiectasis), neuromuscular disease, neurological condition and chest wall deformity, Oxygen should be prescribed to achieve a target saturation of 94–98% for most acutely ill patients or 88–92% or patient-specific target range for those at risk of hypercapnic respiratory failure, Fully trained clinicians should assess all acutely ill patients by measuring respiratory rate, pulse rate, blood pressure and temperature and assessing circulating blood volume and anaemia. British Thoracic Society Emergency Oxygen Guideline Group, BTS Emergency Oxygen Guideline Development Group. The patient/carers should be made aware of the following Health and Safety recommendations: all cylinders should be stored on a cylinder trolley or suitably secured so they cannot be knocked over, there should be no trailing oxygen tubing, a green warning triangle for ‘compressed gas’ should be displayed by the front door (warns emergency services in the event of a fire), the minimum number of cylinders should be stored in the house, there should be no smoking in the vicinity of oxygen cylinders, cylinders must be checked regularly for obvious signs of leakage, cylinders must be kept out of direct sunlight, oxygen must not be used near a naked flame or source of heat. Thorax. A useful and concise summary on oxygen use in the primary care setting. Arterial oxygen tension (PaO, The initial oxygen therapy to be used in the various clinical situations is given (see, If there is a clear history of asthma or heart failure or other treatable illness, appropriate treatment should be instituted in accordance with guidelines or standard management plans for each disease, The oxygen saturation should be monitored continuously until the patient is stable or arrives at hospital for a full assessment. Some GPs in rural areas also carry oxygen in their cars. BTS guideline for oxygen use in adults in healthcare and emergency settings. London, The need for a national guideline for emergency oxygen use was recognised by the British Thoracic Society (BTS) Standards of Care Committee in 2003. However, it is advised that certain safety precautions should be followed: patients are allowed to carry oxygen cylinders for their own use without putting any labels or signs on their vehicle. 2009 Aug;64 Suppl 2:ii1-26. The lack of a prescription should never preclude oxygen being given when needed in an emergency situation. View prescribing informationUK20SX00231December 2020, Following a survey that revealed the impact COVID-19 has had on adults’ mental wellbeing across the country, Public Health England has launched a new campaign to support mental health, This standard operating procedure (SOP) summary describes the operating model and design requirements for safe delivery of COVID-19 vaccines in the community. … The full Guideline for oxygen use in adults in healthcare and emergency settings, published in Thorax1 provides an update to the 2008 BTS Emergency oxygen guideline.2 The following is a summary of the recommendations and good practice points. The sections noted to within this summary refer to the full guideline sections. Conditions for which patients should be monitored closely but oxygen therapy is not required unless the patient is hypoxaemic: myocardial infarction and acute coronary syndromes, hyperventilation or dysfunctional breathing, most poisonings and drug overdoses (see full guideline for carbon monoxide poisoning), acute and subacute neurological and muscular conditions producing muscle weakness. This guideline is intended to provide respiratory physicians and physicians interested in diving medicine with a practical framework on which to base advice. However, a subsequent written record must be made of what oxygen therapy has been given to every patient (in a similar manner to the recording of all other emergency treatment), GPs or first responders visiting a patient’s home should carry a portable pulse oximeter to assess hypoxaemia and guide use of oxygen if available and should call emergency services if hypoxaemia or other serious illness is suspected, Those attending patients as an emergency in rural or remote areas should consider carrying a portable oxygen cylinder as part of their emergency equipment, Patients with COPD (and other at-risk conditions) who have had an episode of hypercapnic respiratory failure should be issued with an oxygen alert card and with a 24% or 28% Venturi mask. A recommended list of oxygen delivery devices for use in pre-hospital care is given above, In patients’ homes, oxygen is usually provided for long-term therapy with an oxygen concentrator and an ambulatory supply with lightweight cylinders (or a portable liquid oxygen system). BTS guideline for oxygen use in adults in healthcare and emergency settings. Leeds Teaching Hospitals COVID Oxygen Guideline – Version 1.1 – 08.04.2020 $ If any patient on 60% O 2 via Venturi or >10L/min O 2 reservoir bag for >1hr, contact LGI CSM (07776 228723/bleep 2928) for LGI wards or SJUH CSM (07776 230473/bleep 5242) for SJUH or CAH wards to allow monitoring of ward O 2 usage. doi: 10.1136/thoraxjnl-2016-209729 pmid: 28507176 BTS guideline for emergency oxygen use in adult patients B R O’Driscoll,1 L S Howard,2 A G Davison3 on behalf of the British Thoracic Society 1 Department of Respiratory Medicine, Salford Royal University Hospital, Salford, UK; 2 Hammersmith Hospital, Imperial College Healthcare NHS Assessment for Ambulatory Oxygen Therapy Guideline WAHT-RES-005 Page 7 of 10 Version 3.4 References British Thoracic Society (2006) Clinical Component for the Home Oxygen Service in England and Wales (Updated January 2006) Burdon JGW, Juniper EF, Killian KJ, Hargrave FE, Campbell EJM. Expert assistance from specialists in intensive care or from other disciplines should be sought at an early stage if patients are thought to have major life-threatening illnesses and clinicians should be prepared to call for assistance when necessary including a call for a 999 ambulance in prehospital care or a call for the resuscitation team or intensive care unit outreach team in hospital care, Oxygen saturation, ‘the fifth vital sign’, should be checked by trained staff using pulse oximetry in all breathless and acutely ill patients (supplemented by blood gases when necessary) and the inspired oxygen device and flow rate should be recorded on the observation chart with the oximetry result, Clinical assessment of a breathless patient starts with ‘ABC’ (Airway, Breathing, Circulation), A brief history should be taken from the patient or other informant, Initial assessment should include pulse and respiratory rate in all cases, Pulse oximetry should always be measured in patients with breathlessness or suspected hypoxaemia, Disease-specific measurements should also be recorded (e.g. Thorax 2017; 72 (Suppl 1): ii1-90. We use cookies to distinguish you from other users of our sites, give you the best online experience, and allow us to improve our sites. Although the majority of evidence comes from the use of oxygen in patients with chronic obstructive pulmonary disease, the scope of the guidance includes patients Issue Date: 15-May-2017 The #NHS NEEDS YOU. An interim update of the BTS guideline is not required at the present time. Although the majority of evidence comes from the use of oxygen in patients with chronic obstructive pulmonary disease, the scope of the guidance … The sections noted to within this summary refer to the full guideline sections. DOI: 10.1136/thoraxjnl-2016-209729 Corpus ID: 9755201. The IOTA meta-analysis showed higher oxygen saturations were associated with higher mortality, but the optimal target range was not clearly defined. Long-term oxygen therapy is covered in other guidelines. This site uses cookies, some may have been set already. The initial British Thoracic Society (BTS) guidelines for the treatment of pneumothoraces were published in 1993.17 Later studies suggested that compliance with these guidelines was improving but remained suboptimal at only 20e40% among non-respiratory and A&E staff. EXECUTIVE SUMMARY Philosophy of the guideline Oxygen is a treatment for hypoxaemia, settings has been endorsed by: Association of British Neurologists. It is recommended that the following delivery devices should be available in prehospital settings where oxygen is administered: high-concentration reservoir mask (non-rebreathe mask) for high-concentration oxygen therapy, nasal cannulae (preferably) or a simple face mask for medium-concentration oxygen therapy, twenty-eight per cent Venturi mask for patients with definite or likely COPD (patients who have an oxygen alert card may have their own 24% or 28% Venturi mask), tracheostomy masks for patients with tracheostomy or previous laryngectomy. BTS guideline for oxygen use in adults in healthcare and emergency settings. The BTS Guideline for oxygen use in adults in healthcare and emergency . In some circumstances, there may be a supply of cylinders for short-term/short-burst therapy or palliative use. Use of oxygen in these patients will be guided by the instructions on the alert card or by a patient-specific protocol which can be shared by hospital teams, the ambulance service and the primary care team. Nice guidelines on the care of dying adults in the last days of life The BTS Standards of Care Committee has recently considered whether the publication of the new evidence in the form of a systematic review and meta-analysis1 provides grounds for an update to certain recommendations within the BTS Guideline for oxygen use in healthcare and emergency settings2. The British Thoracic Society is a Charity registered in England with number 285174, and registered in Scotland with number SC041209. Independent professional body guideline BTS oxygen use in adults guideline. BTS guideline for oxygen use in adults in healthcare and emergency settings BRO’Driscoll,1,2 L S Howard,3 J Earis,4 V Mak,5 on behalf of the British Thoracic Society Emergency Oxygen Guideline Group Additional material is published online only. twitter.com/i/web/status/135... RT @DrSarahSibley1: Physician Associate Assistant Practitioner jobs are open for applications. Read about our cookies here.. By The British Thoracic Society2017-11-07T10:03:00+00:00, This Guidelines summary consists of selected sections of the BTS guideline for oxygen use in adults in healthcare and emergency settings. V30 BTS Emergency Oxygen Guideline Full version 30 November 2015 Page 7 250 8.13.2 Stroke 251 8.13.3 Anxiety and hyperventilation or dysfunctional breathing 252 8.13.4 Poisoning with substances other than carbon monoxide or cyanide 253 … To view please visit the journal online Covers which patients need oxygen therapy and practical aspects of oxygen use 2008 BTS Emergency oxygen guideline.2 The following is a summary of the recom-mendations and good practice points. The sections noted to within this summary refer to the full guideline sections. full guideline … The existence of any oxygen alert card should be asked for so that the emergency services attending can be aware of the target saturation and oxygen supply titrated accordingly. (1982) The perception of breathlessness in asthma. European Respiratory Society guidelines suggest that, in hospital, patients with asthma should have oxygen as the driving gas when acutely ill, or air if they are stable.135 They make no recommendation for use at home, nor do the 1997 BTS guidelines on nebuliser therapy.135 136 If you continue to use the site, we will assume you are happy to accept the cookies anyway. Thorax 2017; 72 (Suppl 1): ii1-90. The need for a national guideline for emergency oxygen use was recognised by the British Thoracic Society (BTS) Standards of Care Committee in 2003. When travelling by car, patients have the freedom to carry their own portable oxygen cylinder. Covers which patients need oxygen therapy and practical aspects of oxygen use British Thoracic Society Emergency Oxygen Guideline Group, BTS Emergency Oxygen Guideline Development Group. The British Thoracic Society (BTS) Home Oxygen Guideline provides detailed evidence-based guidance for the use of home oxygen for patients out of hospital. BTS guideline for oxygen use in adults in healthcare and emergency settings @article{ODriscoll2017BTSGF, title={BTS guideline for oxygen use in adults in healthcare and emergency settings}, author={B. O'Driscoll and L. Howard and J. Earis and V. M{\'a}k}, journal={Thorax}, year={2017}, volume={72}, pages={ii1 - ii90} } doi: 10.1136/thoraxjnl-2016-209729. The purpose of this Guideline is to offer a standardised framework that can be adopted in all areas where oxygen is provided in the acute setting. 1. This includes public transport such as buses or taxis. O'Driscoll BR et al. doi: 10.1136/thx.2008.102947. Visit our Oxygen Clinical Resource page where you will find a number of useful documents to download. home oxygen use during acute exacerbations of respiratory disease—this is covered by the BTS Guideline for Emergency Oxygen … Generally, cylinders with integral high-flow regulators should be ordered. The existing home oxygen supply may be used by a patient or GP in an emergency situation before the arrival of an ambulance using the patient’s existing interface. doi: 10.1136/thx.2009.116020. cylinders must be checked regularly for obvious signs of leakage. They should be instructed to show the card to the ambulance crew and emergency department staff in the event of an exacerbation, Oxygen alert cards with agreed content can be obtained via the BTS website, The content of the alert card should be specified by the physician in charge of the patient’s care, based on previous blood gas results, The primary care team and ambulance service should also be informed by the hospital COPD team that the patient has had an episode of hypercapnic respiratory failure and carries an oxygen alert card. It is an offence to display a hazard diamond if oxygen is not being transported in a vehicle so it is preferable not to use a hazard triangle on private vehicle, the cylinder should be secure within the car and cannot move during transport or in the event of an accident, patients should inform their car insurance company if oxygen is carried in the car, The majority of medical centres and practices should have a supply of oxygen for emergency use. Independent professional body guideline BTS oxygen use in adults guideline. A working party was established with representatives from a wide range of professions involved in oxygen therapy and a lay representative. BTS guidelines for oxygen use in healthcare and emergency settings; BTS guidelines for home oxygen use in adults; Pulmonary Rehabilitation. BTS guideline for emergency oxygen use in adult patients B R O’Driscoll,1 L S Howard,2 A G Davison3 on behalf of the British Thoracic Society 1 Department of Respiratory Medicine, Salford Royal University Hospital, Salford, UK; 2 Hammersmith Hospital, Imperial College Healthcare NHS Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Academy of Medical Sciences Starter Grants - TB research, COVID-19: information for the respiratory community, COVID-19: resumption and continuation of respiratory services, COVID-19: identifying patients for shielding, COVID-19: resources for people with lung disease, COVID-19: advice from government and other organisations, Acute Respiratory Distress Syndrome (ARDS), National Safety Standards for Invasive Procedures - Bronchoscopy and Pleural Procedures, Brighton and Hove City Council and BSUH NHS Trust, National Adult Community Acquired Pneumonia Audit 2018/19, National Adult Non-Invasive Ventilation Audit 2019, BTS Guideline for oxygen use in adults in healthcare and emergency settings, BTS Guideline for Oxygen use in Healthcare and Emergency Settings - Summary of Recommendations, Web Appendix 3 - Summary of guideline for hospital use, Web Appendix 4 - Local Oxygen Policy Template, Web Appendix 5 - Summary for ambulance and prehospital settings, Web Appendix 8 - Slide set for nurses and AHPs, Web Appendix 9 - Key points for hospital managers, Web Appendix 10 - Key points for primary care, Web Appendix 11 - Dissemination and implementation, Summary of recommendations and good practice points (BMJ Open Respiratory Research), Guideline summary for use in ambulances, community and prehospital settings, Key points for hospital managers and oxygen champions, Information on dissemination and implementation of the guideline. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen … EXECUTIVE SUMMARY Philosophy of the guideline Oxygen is a … This management algorithm was developed by a multidisciplinary expert panel: Scadding et al with the support of an educational grant from Mylan. 2008 Oct;63 Suppl 6:vi1-68. British Thoracic Society guidelines for home oxygen use in adults Maxine Hardinge,1 Joe Annandale,2 Simon Bourne,3 Brendan Cooper,4 Angela Evans,5 Daryl Freeman,6 Angela Green,7 Sabrine Hippolyte,8 Vikki Knowles,9 William MacNee,10 Lynn McDonnell,11 Kathy Pye,12 Jay Suntharalingam,13 Vandana Vora,14 Tom Wilkinson,15 British Thoracic Society Home Oxygen Guideline Development Group, on … cylinders must be kept out of direct sunlight. A working party was established with representatives from a wide range of professions involved in oxygen therapy and a … Core principles of asthma management, inhaler selection and use, and referral guidance, from the All Wales Medicines Strategy Group. Serious illnesses requiring moderate levels of supplemental oxygen if the patient is hypoxaemic: deterioration of lung fibrosis or other interstitial lung disease. RT @paimadhu: Amazing to see @LancetGH acknowledge the power imbalance in global health & pledge to amplify the voices of the health worker… BTS guideline for emergency oxygen use in adult patients. These guidelines, drawn up by a panel of 22 experts in paediatric and neonatal medicine, respiratory therapy, and nursing and population health, as well as parents, aimed to define hypoxaemia in children and produce … there should be no smoking in the vicinity of oxygen cylinders. DOI: 10.1136/thoraxjnl-2016-209729 Corpus ID: 9755201. The production and printing of this Guidelines summary card has been commissioned by Novo Nordisk Ltd. Information intended for UK healthcare professionals only. The purpose of this Guidelines summary is to maximise the safety of patients with cystic fibrosis and make the best use of NHS resources, while protecting staff from infection. Balfour-Lynn IM(1), Field DJ, Gringras P, Hicks B, Jardine E, Jones RC, Magee AG, Primhak RA, Samuels MP, Shaw NJ, Stevens S, Sullivan C, Taylor JA, Wallis C; Paediatric Section of the Home Oxygen Guideline Development Group of the BTS Standards of Care … BTS guideline for emergency oxygen use in adult patients Thorax. If a GP is attending a patient at home with oxygen, ideally, the use of oxygen should be guided by pulse oximetry. The guideline recommends aiming to achieve normal or near-normal oxygen saturation for all acutely ill patients apart from those at risk of hypercapnic respiratory failure or those receiving terminal palliative care. settings has been endorsed by: Association of British Neurologists. Please let us know if you agree to all of these cookies. The current recommendations state that the recommended target saturation range for acutely ill patients not at risk of hypercapnic respiratory failure is 94–98% and for those with known COPD, or other known risk factors for hypercapnic respiratory failure, a target saturation range of 88–92% is suggested, pending the availability of blood gas results. NICE shared learning on a pulmonary rehabilitation for ILD; BTS guidelines on pulmonary rehabilitation in adults; End-of-life care. The British Thoracic Society (BTS) Home Oxygen Guideline provides detailed evidence-based guidance for the use of home oxygen for patients out of hospital. 2017 Jun;72(Suppl 1):ii1-ii90. In response to the conclusions drawn from the systematic review and meta-analysis on mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA)1, the BTS Standards of Care Committee notes that the major thrust of the guideline was to mandate the use of controlled vs liberal oxygen therapy; thus, the overall messages from the BTS guideline2 and the systematic review1 are aligned in stating that controlling oxygen to a target saturation is paramount. British Thoracic Society (BTS) Standards of Care Committee therefore established a Working Party to formulate national recommendations for assess-ing respiratory fitness to dive. It will also enable services to match capacity to patient needs if services become limited because of the COVID-19 pandemic. We would like to show you a description here but the site won’t allow us. Special care should be taken if twin oxygen outlets are in use, Chronically hypoxaemic patients with a clinical exacerbation associated with a 3% or greater fall in oxygen saturation on their usual oxygen therapy should usually be assessed in hospital with blood gas estimations. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Registered as a company limited by guarantee in England and Wales with number 1645201. O’Driscoll B, Howard L, Earis J, et al. Alternatively, oxygen cylinders fitted with high-flow regulators (delivering up to 15 l/min) must be used to allow use with reservoir masks, Healthcare organisations should take measures to eliminate the risk of oxygen tubing being connected to the incorrect wall oxygen outlet or to outlets that deliver compressed air or other gases instead of oxygen. Please refer to the full guideline at www.brit-thoracic.org.uk/standards-of-care/guidelines/bts-guideline-for-emergency-oxygen-use-in-adult-patients for the complete set of recommendations, www.brit-thoracic.org.uk/standards-of-care/guidelines/bts-guideline-for-emergency-oxygen-use-in-adult-patients/. BTS guideline for oxygen use in adults in healthcare and emergency settings @article{ODriscoll2017BTSGF, title={BTS guideline for oxygen use in adults in healthcare and emergency settings}, author={B. O'Driscoll and L. Howard and J. Earis and V. M{\'a}k}, journal={Thorax}, year={2017}, volume={72}, pages={ii1 - ii90} } The British Thoracic Society (BTS) Guideline for Emergency Oxygen Use in Adult Patients (Thorax, 2008;63[Suppl VI]) is the first national (UK) guideline on this topic, aimed at simplifying oxygen delivery and better protecting acutely ill patients. where you will find a number of useful documents to download. Air flow meters should be removed from the wall sockets or covered with a designated air outlet cover when not in use. BTS guidelines for home oxygen in children Thorax. 2009 Aug;64 Suppl 2:ii1-26. Thorax (2017) 72(Suppl 1):ii1-ii90. 2008 BTS Emergency oxygen guideline.2 The following is a summary of the recom-mendations and good practice points. British Thoracic Society This led to the production of the 2008 BTS Guideline for emergency oxygen use in adult patients which was the world's first guideline for emergency oxygen therapy.1 This guideline has been implemented throughout the UK and in many other countries leading to over 500 citations in the medical literature up to the end of 2016. A useful and concise summary on oxygen use in the primary care setting. The To view please visit the journal online The oxygen concentration should be adjusted upwards or downwards to maintain the target saturation range, In most emergency situations oxygen is given to patients immediately without a formal prescription or drug order. BTS guideline for oxygen use in adults in healthcare and emergency settings. The guideline development group was aware of existing BTS guidelines in related areas and the following areas therefore fall outside the scope of this guideline: home oxygen in children (younger than 18)—home oxygen in children remains as a separate guideline.1. Lancet (2018) 391(10131):1693-1705, 2. The British Thoracic Society (BTS) Emergency Oxygen Guideline, published in 2008, addresses many of the issues surrounding the use and prescribing of oxygen, specifically regarding target saturation ranges . doi: 10.1136/thx.2009.116020. The home address and ideal oxygen concentration or target saturation ranges of these patients can be flagged in the ambulance control systems and information disseminated to ambulance crews when required, When possible, out-of-hours services providing emergency primary care services should be informed by the hospital COPD team or by the primary care team that the patient has had an episode of hypercapnic respiratory failure and carries an oxygen alert card. COPD and other conditions requiring controlled or low-dose oxygen therapy: COPD and other conditions causing fixed airflow obstruction (e.g. This site is intended for UK healthcare professionals, Guidelines Live 2020—now available on demand, www.brit-thoracic.org.uk/standards-of-care/guidelines/bts-guideline-for-emergency-oxygen-use-in-adult-patients, NICE Technology Appraisal 664: Liraglutide for managing overweight and obesity, PHE launches nationwide Every Mind Matters campaign, COVID-19 rapid guideline: cystic fibrosis, Identifying and managing allergic rhinitis in the asthma population. British Thoracic Society has released its Guideline for oxygen use in healthcare and emergency settings.The guidance is based on new evidence about … Chu DK et al. 2017-11-07T10:03:00. Welcome to Guidelines. BTS Emergency Oxygen Guideline Full version 15 November 2016 Page 4 3.1.5 Variation in oxygen saturation during sleep 3.1.6 Normal range for arterial carbon dioxide tension (PaCO2) 3.2 Definitions of hypoxaemia, hypoxia, type 1 respiratory failure and hyperoxaemia 3.3 Definition of hypercapnia and type 2 respiratory failure The BTS Guideline for oxygen use in adults in healthcare and emergency . In February, 2019, the American Thoracic Society (ATS) released new guidance for home oxygen therapy in children with chronic respiratory conditions. peak expiratory flow in asthma, blood pressure in cardiac disease), Emergency oxygen should be available in primary care medical centres, preferably using oxygen cylinders with integral high-flow regulators. Authors B R O'Driscoll 1 , L S Howard, A G Davison, British Thoracic Society.

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