It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation. A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital. Patients randomised to liberal oxygen therapy were more likely to die (risk ratio 1.21 (95% confidence interval 1.03 to 1.43)). The increase in mortality was highest in the trials with the greatest increase in SpO2; this suggests a dose-response relation and strengthens the inference that excessive oxygen is a cause of death. The review included 25 randomised controlled trials. This BMJ Rapid Recommendation article is one of a series that provides clinicians with trustworthy recommendations for potentially practice changing evidence. Three people with lived experience of acute medical conditions requiring hospitalisation were members of the panel. They identified and rated outcomes, and helped lead the discussion on values and preferences in a videoconference and email discussions before the full panel meetings.

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