Therapeutic effects of hyperoxic ventilation during shock

Abstract

SUMMARY Decreased availability of oxygen to metabolizing cells is a major feature of circulatory shock that leads to tissue damage and multiple organ dysfunctions. A wish to alleviate tissue hypoxia underlies the common clinical use of hyperoxic ventilation in shock. Yet, this straightforward approach is met by skepticism that is based on the potential pro‐inflammatory effects of hyperoxia and the acknowledged roles of reactive oxygen species and oxidative stress in tissue injury. A steadily growing body of experimental data indicates that hyperoxia exerts an extensive profile of physiologic and pharmacologic effects that improve tissue oxygenation, exert anti‐inflammatory and antibacterial effects, augment tissue repair mechanisms, and may also decrease oxidative stress during shock. The currently available preclinical information on the benefits of early use of safe regimens of hyperoxic ventilation alone or in combination with other commonly employed modalities sets the stage for renewal of careful clinical evaluation of oxygen therapy in resuscitation of circulatory shock.

Hypoxia and hyperoxia differentially control proliferation of rat neural crest stem cells via distinct regulatory pathways of the HIF1α–CXCR4 and TP53–TPM1 proteins

“…On the other hand, hyperoxia‐induced oxidative stress and oxygen toxicity are major issues of concern in the process of ventilatory oxygen therapy or diving (Thorsen et al, ; Alcaraz‐Garcia et al, ; Bitterman, ; Martin and Grocott, ). Previous studies have demonstrated that an FiO 2 at higher than 90% is lethal and inhibits proliferation and induces apoptosis of both endothelial and epithelial cells via TGFβ‐, NF‐κB‐, or TP53‐dependent signaling pathways (Horowitz, ; O’Reilly, ).…”

Editorial: the Janus face of oxygen

“…The current issue of Transfusion Alternatives in Transfusion Medicine highlights the potential as well as the perils of hyperoxic ventilation as a method to stabilize tissue oxygenation with articles dealing with hyperoxia in myocardial infarction, 5 traumatic brain injury 6 and different types of shock 7 . In the first article, Conti comprehensively describes the effects of high inspiratory O 2 concentrations during acute myocardial infarction 5 .…”

“…The effects of hyperoxic ventilation as treatment of hemorrhagic shock are ambiguous. In his exhaustive review, Bitterman demonstrates that hyperoxia induces an extensive profile of physiological and pharmacological effects that improve tissue oxygenation, exert anti‐inflammatory and antibacterial effects, augment tissue repair mechanisms, and may also decrease oxidative stress during shock 7 . However, in this setting as well, hyperoxic ventilation has the highest efficacy in situations where arteriolar constriction is diminished by anemia‐induced vasodilation or by hypoxia‐sustained perfusion of the vascular bed.…”

“…The current issue of Transfusion Alternatives in Transfusion Medicine highlights the potential as well as the perils of hyperoxic ventilation as a method to stabilize tissue oxygenation with articles dealing with hyperoxia in myocardial infarction, 5 traumatic brain injury 6 and different types of shock. 7 In the first article, Conti comprehensively describes the effects of high inspiratory O2 concentrations during acute myocardial infarction. 5 Despite its widespread use in this indication and the general guideline recommendation to administer supplemental O2 in the first 6 hours in acute uncomplicated myocardial infarction, in fact the efficacy of O2 has never been proven unequivocally for this situation.…”