Oxygen Therapy: Too much is bad | Article Summary
Benefits and harms of supplemental oxygen administration in ICU for critically ill patients
Article featured in ICU management and practice. Bruno Pastene and Marc Leone, Department of and Intensive Care Unit, Hospital Nord Assistance Publique Hôpitaux de Marseille.
Article overview
Oxygen is administered routinely in ICU settings, but are we considering all the risks?
In this article Bruno Pastene and Marc Leone explore the existing literature on the benefits and harms of supplemental oxygen administration in ICU for critically ill patients. They highlight that across clinical studies and found that across clinical studies, there are inconsistencies in the definition of hyperoxia which has led to inconsistencies in findings. (Barbateskovic et al. 2019; Damiani et al. 2014).
Increasing evidence suggests that exposure to hyperoxia during critical illness is associated with impaired outcomes and that conservative oxygen therapy should be a future recommendation in most guidelines. (Barbateskovic et al. 2019; Chu et al. 2018).
“Whereas hypoxia may be viewed as a natural response to injury, hyperoxia is never found except in conditions generated by human interventions. In this sense, oxygen should be assessed as a drug with possible side effects in case of overdosage.”
(B. Pastene, M. Leone 2021)
Risks of Hyperoxia
Pastene and Leone also explore the reported risks of hyperoxia from several randomised trials studied the effects of prolonged hyperoxia by reporting mortality rates in patients treated with a liberal oxygen therapy compared to patients treated with conservative strategy. This was also compounded by studies on the effects of hyperoxia on different indications such as sepsis, post- cardiac arrest, brain injuries and chest trauma.
These trials concluded that although the risks associated with hypoxemia are great, there are also poor outcomes associated with the administration of high levels of oxygen including increased mortality risks.
Conclusion
In critically ill patients, the trend is to administer high levels of oxygen to counteract the risks of hypoxaemia. This can lead to poor patient outcomes, and it is important to ensure oxygen is not used unnecessarily or administered longer than required. Recommendations are to adopt a less is more strategy and develop personalised approaches to keep patients within the safe zone of the U-shaped curve of hypoxaemia and hyperoxia (Figure a).
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Find out more
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Benefits of FreeO2
Patient benefits
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Healthcare workers
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Trust benefits
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