Oxygen Use in Critical Illness

O’Driscoll, B R; Smith, Rachel M.

doi:10.4187/respcare.07044

Cited by 23 publications

(32 citation statements)

References 76 publications

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“…patients with respiratory failure (3). Patients requiring both MV and supplemental oxygen to treat acute lung injury have a high mortality rate of around 45% (4).…”

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confidence: 99%

“…Over 2 million patients receive invasive mechanical ventilation (MV) each year in the United States (20–40% of all patients admitted to ICU) at an estimated cost of $27 billion ( 1 , 2 ). As part of this treatment, all of these patients will receive supplemental oxygen to prevent hypoxemia; oxygen is one of the most commonly prescribed drugs in medicine and a lifesaving treatment for patients with respiratory failure ( 3 ). Patients requiring both MV and supplemental oxygen to treat acute lung injury have a high mortality rate of around 45% ( 4 ).…”

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confidence: 99%

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Oxygen Targets During Mechanical Ventilation in the ICU: A Systematic Review and Meta-Analysis

Cumpstey

Oldman

Martin

et al. 2022

Critical Care Explorations

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OBJECTIVES: Patients admitted to intensive care often require treatment with invasive mechanical ventilation and high concentrations of oxygen. Mechanical ventilation can cause acute lung injury that may be exacerbated by oxygen therapy. Uncertainty remains about which oxygen therapy targets result in the best clinical outcomes for these patients. This review aims to determine whether higher or lower oxygenation targets are beneficial for mechanically ventilated adult patients. DATA SOURCES: Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, and Cochrane medical databases were searched from inception through to February 28, 2021. STUDY SELECTION: Randomized controlled trials comparing higher and lower oxygen targets in adult patients receiving invasive mechanical ventilation via an endotracheal tube or tracheostomy in an intensive care setting. DATA EXTRACTION: Study setting, participant type, participant numbers, and intervention targets were captured. Outcome measures included “mortality at longest follow-up” (primary), mechanical ventilator duration and free days, vasopressor-free days, patients on renal replacement therapy, renal replacement free days, cost benefit, and quality of life scores. Evidence certainty and risk of bias were evaluated using Grading of Recommendations Assessment, Development and Evaluation and the Cochrane Risk of Bias tool. A random-effects models was used. Post hoc subgroup analysis looked separately at studies comparing hypoxemia versus normoxemia and normoxemia versus hyperoxemia. DATA SYNTHESIS: Data from eight trials (4,415 participants) were analyzed. Comparing higher and lower oxygen targets, there was no difference in mortality (odds ratio, 0.95; 95% CI, 0.74–1.22), but heterogeneous and overlapping target ranges limit the validity and clinical relevance of this finding. Data from seven studies (n = 4,245) demonstrated targeting normoxemia compared with hyperoxemia may reduce mortality at longest follow-up (0.73 [0.57–0.95]) but this estimate had very low certainty. There was no difference in mortality between targeting relative hypoxemia or normoxemia (1.20 [0.83–1.73]). CONCLUSIONS: This systematic review and meta-analysis identified possible increased mortality with liberal oxygen targeting strategies and no difference in morbidity between high or low oxygen targets in mechanically ventilated adults. Findings were limited by substantial heterogeneity in study methodology and further research is urgently required to define optimal oxygen therapy targets.

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“…patients with respiratory failure (3). Patients requiring both MV and supplemental oxygen to treat acute lung injury have a high mortality rate of around 45% (4).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Oxygen Targets During Mechanical Ventilation in the ICU: A Systematic Review and Meta-Analysis

Cumpstey

Oldman

Martin

et al. 2022

Critical Care Explorations

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“…However, the safest level of oxygen for these critically ill patients is unknown. 12 Helmerhorst et al 13 reported increased mortality with marked hyperoxia (> 200 mm Hg) and time spent in this hyperoxic state has a linear relationship with hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Adherence to an Oxygen-Weaning Protocol in Mechanically Ventilated Adults in the Medical ICU

et al. 2020

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BACKGROUND: Patients undergoing mechanical ventilation in the ICU often receive supplemental oxygen. If not closely monitored, this may lead to hyperoxia. The use of an oxygen-weaning protocol may reduce this risk by pacing the titration of oxygen therapy to patient needs. ICU protocols are correlated with decreased mortality and length of stay and have great potential for cost savings. The goals of this study were to determine whether the oxygen-weaning protocol at a university-affiliated hospital was followed and to measure the length of time respiratory therapists took to wean patients once the oxygen-weaning parameters were met. METHODS: This was a retrospective chart review of subjects > 18 y of age admitted to the medical ICU who underwent intubation and mechanical ventilation and were placed on an oxygen therapy protocol. The following data were collected: demographics, arterial blood gases, the length of time to change F IO 2 after meeting weaning parameters, and the percent change in F IO 2. RESULTS: Data were collected from 30 subjects. The most common oxygen saturation parameter measured via pulse oximetry (S pO 2) used to initiate weaning oxygen was 92%. The mean 6 SD F IO 2 administered to subjects was 39.6 6 15.3% prior to extubation. The majority of subjects exhibited adequate oxygenation prior to extubation (mean 6 SD): P aO 2 99.3 6 6.7 mm Hg, S aO 2 95.1 6 26.9%. The mean 6 SD length of time to the first change in F IO 2 from the time a subject met the weaning criteria was 9.1 6 10.6 h (range 1-39 h; interquartile range 2-13 h). CONCLUSIONS: Subjects admitted to the medical ICU who were intubated, mechanically ventilated, and placed on the oxygen therapy protocol experienced a significant delay in oxygen weaning. Closer monitoring and adherence to the oxygen-weaning protocol should be considered to reduce the potential risk for hyperoxia. Key words: oxygen weaning; weaning protocols; oxygen titration protocol; patient-driven protocols; protocol adherence; weaning indices.

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“…La necesidad de establecer guías de manejo es de suma importancia en el manejo cotidiano de los pacientes y el oxígeno al ser considerado un medicamento posee efectos benéficos y posibles efectos adversos a la salud [1]. Como mecanismos de daño directo del oxígeno se conoce la formación de radicales libres de oxígeno y vasoconstricción hiperoxemica [2]; así como mecanismos que inducen a la hipercapnia tales como disminución del impulso respiratorio, efecto Haldane y alteración V/Q [3].…”

Section: Transferencia En La Práctica De Dr Cecilio Omar Ceballos-zuñ...unclassified

Rompiendo el paradigma en la oxigenoterapia

Ceballos-Zuñiga¹

2022

Kompass Neumol

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Background: Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. Methods: A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System («The Oxford 2011 Levels of Evidence») was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. Results: The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. Conclusion: This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.

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Oxygen Use in Critical Illness

Cited by 23 publications

References 76 publications

Oxygen Targets During Mechanical Ventilation in the ICU: A Systematic Review and Meta-Analysis

Oxygen Targets During Mechanical Ventilation in the ICU: A Systematic Review and Meta-Analysis

Adherence to an Oxygen-Weaning Protocol in Mechanically Ventilated Adults in the Medical ICU

Rompiendo el paradigma en la oxigenoterapia

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