Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation

James, Stefan; Erlinge, David; Herlitz, Johan; Alfredsson, Joakim; Koul, Sasha; Fröbert, Ole; Kellerth, Thomas; Ravn-Fischer, Annica; Alström, Patrik; Östlund, Ollie; Jernberg, Tomas; Lindahl, Bertil; Hofmann, Robin; Svensson, Leif; Witt, Nils; Frick, Mats; Ekström, Mattias; Linder, Rickard; Nilsson, Lennart; Zughaft, David; Ekelund, Ulf; Ömerovic, Elmir; Jacobsson, Eva

doi:10.1016/j.jcin.2019.09.016

Cited by 23 publications

(18 citation statements)

References 29 publications

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“…No change was, however, found in the odds ratios for 30 day or one year mortality for the group receiving high oxygen compared with low oxygen when analysis also included adjustment for first SpO 2 . A secondary analysis from DETO2X-AMI also reported a much higher mortality for patients with an SpO 2 of less than 95%, but no difference in mortality, reinfarction, or hospital admission for heart failure over the next 1-4 years between liberal and conservative oxygen protocols 17…”

Section: Discussionmentioning

confidence: 95%

High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial

Stewart

Jones

Dicker

et al. 2021

BMJ

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Objective To determine the association between high flow supplementary oxygen and 30 day mortality in patients presenting with a suspected acute coronary syndrome (ACS). Design Pragmatic, cluster randomised, crossover trial. Setting Four geographical regions in New Zealand. Participants 40 872 patients with suspected or confirmed ACS included in the All New Zealand Acute Coronary Syndrome Quality Improvement registry or ambulance ACS pathway during the study periods. 20 304 patients were managed using the high oxygen protocol and 20 568 were managed using the low oxygen protocol. Final diagnosis of ST elevation myocardial infarction (STEMI) and non-STEMI were determined from the registry and ICD-10 discharge codes. Interventions The four geographical regions were randomly allocated to each of two oxygen protocols in six month blocks over two years. The high oxygen protocol recommended oxygen at 6-8 L/min by face mask for ischaemic symptoms or electrocardiographic changes, irrespective of the transcapillary oxygen saturation (SpO 2 ). The low oxygen protocol recommended oxygen only if SpO 2 was less than 90%, with a target SpO 2 of less than 95%. Main outcome measure 30 day all cause mortality determined from linkage to administrative data. Results Personal and clinical characteristics of patients managed under both oxygen protocols were well matched. For patients with suspected ACS, 30 day mortality for the high and low oxygen groups was 613 (3.0%) and 642 (3.1%), respectively (odds ratio 0.97, 95% confidence interval 0.86 to 1.08). For 4159 (10%) patients with STEMI, 30 day mortality for the high and low oxygen groups was 8.8% (n=178) and 10.6% (n=225), respectively (0.81, 0.66 to 1.00) and for 10 218 (25%) patients with non-STEMI was 3.6% (n=187) and 3.5% (n=176), respectively (1.05, 0.85 to 1.29). Conclusion In a large patient cohort presenting with suspected ACS, high flow oxygen was not associated with an increase or decrease in 30 day mortality. Trial registration ANZ Clinical Trials ACTRN12616000461493.

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Section: Discussionmentioning

confidence: 95%

High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial

Stewart

Jones

Dicker

et al. 2021

BMJ

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“…Our ndings were consistent with the results of studies that evaluated the impacts of supplemental oxygen therapy in other clinical settings. Several RCTs and meta-analyses have demonstrated that oxygen therapy does not signi cantly reduce all-cause mortality, and can even increase the incidence of early myocardial injury and infarct size among AMI patients with normoxemia (8,(10)(11)(12)(13)(29)(30)(31)(32)(33). A total of eleven RCTs including 6,366 patients with acute stroke showed a nonsigni cant increase in mortality at three, six, and twelve months in patients who received normobaric oxygen compared with those who received ambient air (34).…”

Section: Discussionmentioning

confidence: 99%

“…This topic has been studied in other non-AHF clinical settings. For example, several randomized controlled trials (RCTs) have demonstrated that supplemental oxygen had no clinical bene ts among patients without hypoxemia presenting with acute myocardial infarction (AMI) and others have suggested possible harm (10)(11)(12)(13)(14)(15). Considering the contradictory ndings regarding supplemental oxygen therapy, recent HF guidelines diverge from the previous consensus that oxygen should be administered routinely among AHF patients irrespective of oxygen saturation at baseline (16)(17)(18).…”

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confidence: 99%

Is oxygen therapy beneficial for normoxemic patients with acute heart failure? A propensity score matched study

Yao

Zhang

et al. 2020

Preprint

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Background The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure (AHF) who do not have hypoxemia. The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data.Methods Normoxemic patients diagnosed with AHF on ICU admission from the electronic ICU (eICU) Collaborative Research Database were included in the current study, in which the study population was divided into the oxygen therapy group and the ambient-air group. Propensity score matching (PSM) was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air. Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay (LOS), and all-cause in-hospital as well as ICU mortality rates, respectively. A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings.Results A total of 2,922 normoxemic patients with AHF were finally included in the analysis. Overall, 42.1% (1,230/2,922) patients were exposed to oxygen therapy, and 57.9% (1,692/2,922) patients did not receive oxygen therapy (defined as the ambient-air group). After PSM analysis, 1,122 pairs of patients were matched: each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen. The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen group for all-cause in-hospital mortality (odds ratio [OR] 1.30; 95% confidence interval [CI] 0.92–1.82; P=0.138) or ICU mortality (OR 1.39; 95% CI 0.83–2.32; P༝0.206) in the post-PSM cohorts. In addition, linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS (OR 1.11; 95% CI 1.06–1.15; P༜0.001) and hospital LOS (OR 1.06; 95% CI 1.01–1.10; P༝0.009) after PSM. Furthermore, the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups.Conclusions Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all-cause in-hospital mortality or ICU mortality.

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“…Penggunaan oksigen dalam kisaran normal -rendah, dapat mencegah terjadinya hipoksemia dan mengurangi ketidakcocokan pasokan dan permintaan oksigen dalam miokard infark sehingga ukuran infark dapat dikurangi dan meminimalkan terjadinya komplikasi. Sedangkan pada penggunaan oksigen dengan batas normal -tinggi, terapi oksigen dapat mengakibatkan hiperoksemia (tingginya tekanan oksigen dalam darah) yang dapat berpontesi menyebabkan disfungsi kontraktil miokard toksik, meningkatnya stres oksidatif, cedera reperfusi, dan akhirnya kematian sel miokard (James et al, 2019). Sedangkan menurut Sepehrvand & Ezekowitz (2016), pemberian terapi oksigen direkomendasikan untuk mengelola hipoksemia (saturasi oksigen perifer <90% hingga 94% atau pasien dengan tekanan oksigen arteri parsial <60 mmHg) selain itu pemberian terapi oksigen digunakan untuk meningkatkan oksigen jaringan miokard yang sakit.…”

Section: Kasus Eunclassified

Management Pengoptimalan Kebutuhan Oksigen Pada Pasien Gagal Jantung Di Unit Perawatan Intensif: A Literatur Review

Rahayu

2020

Jurnal Berita Ilmu Keperawatan

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Heart failure occurs with symptoms associated with an impaired myocardial ventricular function other than that heart failure manifests as vascular congestion in the pulmonary and systemic circulation resulting in symptoms of insufficient circulation. The main treatment in patients with heart failure with sufficient oxygenation needs. Objective: to find out how to optimize the oxygen needs of heart failure patients. Method: This study uses a literature review method that focuses on fulfilling the oxygen needs of heart failure patients by searching Google Scholar, Elsevier, and Pubmed by using keywords heart failure, oxygenation, respiratory, and heart rate in the period 2015 - 2020. Results: the search found more than 500 case reports according to keywords and then filtered, obtained 5 case report articles. The journal describes the case of heart failure patients and how to cope with oxygen demand in heart failure patients who often experience shortness of breath or hypoxemia. Conclusion: oxygenation therapy for heart failure patients can be done by using ventilation aids and adjusting the patient's position according to the patient's condition and complications

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Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation

Cited by 23 publications

References 29 publications

High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial

High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial

Is oxygen therapy beneficial for normoxemic patients with acute heart failure? A propensity score matched study

Management Pengoptimalan Kebutuhan Oksigen Pada Pasien Gagal Jantung Di Unit Perawatan Intensif: A Literatur Review

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