Question: With the new recommendations for oxygen during the pandemic, Im a bit confused as to what to do if my patient needs >5L NP?

The latest OBHG memo detailed recommendations for oxygen therapy (here).  To summarize:

Nasal prongs up to 5L/minute can be used to titrate to a SpO₂ of 92-96% or 88-92% in COPD patients, per the Oxygen Therapy Standard of the BLS.  Note that the lower end of these targets is recommended to minimize risk of aerosolization with higher flows.

If a higher concentration of oxygen is required to achieve an SpO2 of 92% (or 88% in COPD patients), then use a high concentration/low flow mask with a hydrophobic submicron filter.

The same goes for pediatric patients (if the high concentration/low flow mask is available).

Remember that high flow oxygen delivery should be avoided (unless via SGA/ETT) and that the use of these advanced airways are only for patients in cardiac arrest.  The reason being that high flow oxygen is an Aerosol Generating Medical Procedure (AGMP) that puts the paramedics, bystanders and the community at risk for spread of the virus.  Therefore, if high flow or advanced airways must be used, N-95 respirators along with other appropriate PPE must be worn by anyone within 6 feet of the procedure.

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AGMP, COVID-19

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