Oxygen therapy is administered to patients to decrease tissue hypoxia and to relieve arterial hypoxemia. High concentrations of oxygen often are used for short periods of time in patients with acute respiratory illnesses, and concentrations only slightly higher than ambient levels are administered for much longer time periods to patients with chronic respiratory diseases. Supplying oxygen to plants, animals, or bacteria has long been known to produce varying amounts of tissue damage; toxicity increases as concentrations of oxygen or the pressure used during exposure increases. End-organ damage from hyperoxia depends on both the concentration of oxygen administered and the pressure during the exposure. Prolonged exposure to hyperbaric oxygen (> 2.5 atmosphere of pressure) causes both central nervous system and pulmonary toxicity that results in atelectasis, pulmonary edema, and seizures. Lung damage as a result of normobaric hyperoxia is the predominant manifestation of toxicity. A severe retinopathy (retrolental fibroplasia) also can occur in neonates during oxygen exposures at ambient pressure, and cases have been reported to occur with only modest increases in inspired oxygen concentrations. For these reasons, the lowest possible concentration of oxygen that relieves tissue hypoxia is administered to patients, and the oxygen concentration is stabilized when the desired therapeutic goals are accomplished.
Risks of Oxygen TherapyThree distinct types of risks can occur in patients who receive supplemental oxygen therapy. These include physical risks, detrimental physiological effects, and actual cellular toxicity that involves a number of different organs. The physical risks are a result of oxygen's combustibility and the potential of fire occurring in an area where supplemental oxygen is being administered. Smoking or the use of open-flame heating devices in areas where oxygen is being administered should be prohibited for all patients receiving oxygen therapy.Oxygen-induced changes in physiology found in animals and in some human studies include ventilatory and cardiac output depression, suppression of erythropoiesis, vasodilation of the pulmonary vasculature, and vasoconstriction of the systemic vasculature (Table 1) [1-6]. These types of physiological effects usually are rapidly reversible and are well tolerated by normal people. Ventilatory depression is a very serious side effect of oxygen therapy in patients with chronic obstructive pulmonary disease and can cause hypercapnia that results in acute respiratory failure. This group of patients requires arterial hypoxemia as a stimulus for breathing because of depression of their central respiratory center responses to elevated carbon dioxide tensions.