oxygen therapy
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Introduction
Inhalation therapy with molecular oxygen
Indications
(also see home oxygen)
- PaO2 =< 55 mm Hg
- PaO2 =< 59 mm of Hg with clinical evidence of pulmonary hypertension, polycythemia or cor pulmonale[2]
- SaO2 =< 88% at rest or with exercise
- persistent polycythemia
- hemoglobin (Hgb) > 18 g/dL
- hematocrit (Hct) > 54%
- recurrent cor pulmonale
- severe hypoxemia
- CNS symptoms induced by hypoxemia, reversed by oxygen
* SaO2 not to exceed 94-96% with oxygen therapy[7]
Contraindications
- palliatative oxygen no better than room air in terminally ill patients with pO2 > 55 mm Hg[4]
- higher mortality with liberal use of supplemental oxygen in acutely ill patients[6]
- SaO2 > 90-93%[7]
Procedure
(for medical oxygen use)
Guidelines:
- continuous O2 is more useful than nocturnal O2.
- reassess need for chronic O2 treatment after 3 months
- fiO2 generally increases by 3% for each liter flow of O2
- Venturi mask provides fine control of O2 delivery
- use O2 sparingly in patients with increased pCO2
- 100% O2 denitrogenates the lungs to provide an O2 reserve
- conservative oxygen therapy is associated with lower mortality in the ICU (12% vs 20%)[5]
- similar outcomes with low normal 80 mm Hg vs high normal 96 mm Hg PaO2 in patients with critical illness SIRS[9]
Oxygen delivery systems (storage devices):
- oxygen concentrator (least expensive)
- oxygen cylinders (provide highest O2 flow rates)
- stationary H size cylinder (70 kg)
- portable steel size E cylinder (7 kg) on wheels
- portable unit of liquid oxygen linked to a demand pulse oxygen-conserving device (most expensive)
* video[8]
Complications
(oxygen toxicity)
- respiratory distress syndrome
- risk increases when:
- not amenable to treatment
- patients generally succumb to lung failure
- histopathology
- early exudative phase
- irreversible proliferative fibrotic phase
- excess cardiac arrhythmias, lung injuries in hospitalized patients without hypoxemia[6]
More general terms
More specific terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 743, 763
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998
- ↑ Taha SK et al, Nasopharyngeal oxigen insufflation following preoxygenation using the four deep breath technique Anaesthesia 2006; 61:427 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16674614
- ↑ 4.0 4.1 Abernethy AP et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: A double-blind, randomised controlled trial. Lancet 2010 Sep 4; 376:784. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20816546
- ↑ 5.0 5.1 5.2 Girardis M, Busani S, Damiani E et al Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit. The Oxygen-ICU Randomized Clinical Trial. JAMA. Published online October 5, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27706466 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2565306
Ferguson ND Oxygen in the ICU. Too Much of a Good Thing? JAMA. Published online October 5, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27706469 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2565302 - ↑ 6.0 6.1 6.2 Chu DK, Kim LH, Young PJ et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): A systematic review and meta-analysis. Lancet 2018 Apr 28; 391:1693. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29726345 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30479-3/fulltext
McEvoy JW. Excess oxygen in acute illness: Adding fuel to the fire. Lancet 2018 Apr 28; 391:1640 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29726326 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30546-4/fulltext - ↑ 7.0 7.1 7.2 Siemieniuk RAC, Chu DK, Kim LHY et al Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ 2018;363:k4169 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30355567 https://www.bmj.com/content/363/bmj.k4169
- ↑ 8.0 8.1 Rengasamy S, Nassef B, Bilotta F et al Videos in Clinical Medicine. Administration of Supplemental Oxygen. N Engl J Med 2021; 385:e9. July 15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34260838 https://www.nejm.org/doi/full/10.1056/NEJMvcm2035240
- ↑ 9.0 9.1 Gelissen H, de Grooth HJ, Smulders Y et al. Effect of low-normal vs high-normal oxygenation targets on organ dysfunction in critically ill patients: A randomized clinical trial. JAMA 2021 Aug 31; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34463696 https://jamanetwork.com/journals/jama/article-abstract/2783810