# 266 O2 NOT good?
Recent research has been building a conclusion that administering oxygen is not always a 'good thing'. Patients getting too much oxygen may have worse recovery, more deficit, and more deaths than studied groups who are normoxic during their period of care. During hyperoxia, the complex metabolism and usage of oxygen may create "reactive species" which alter cellular functioning.
Traditionally, oxygen was a 'good thing' to be given freely and generously for many problems; and a student's safe answer to questions. Faith, trust, and medical dogma encouraged a provider's self-comfort and a feeling of 'doing something'.
Previously, it was difficult to study deleterious effects in so many different arenas of care, with disparate personnel, environments, philosophy, and needs. These are now being looked at more closely.
It now appears that it's safer to be more frugal with oxygenation. Hypoxemia can be treated with oxygen to a normoxic level, provided there is no hypercarbia (which is treated with ventilation). The patient should be watched for the need for increased effort or distress in maintaining a satisfactory level.
The patient who remains oxygen dependent should have it efficiently delivered, rather than by leaky masks and cannulae that do not provide enough volume for needs at a controlled O2 concentration.
As always, manual ventilation with a bag by a person not keeping track of rates, volumes, and pressures, may create adverse hemodynamic changes within the chest that may prevent resuscitation and survival. Automatic transport ventilators may be the preferred device.
Watch the patient. Treat the patient! Be alert to change.
Roberts, B. W., Kilgannon, J. H., Hunter, B. R., Puskarich, M. A., Pierce, L., Donnino, M., ... & Abella, B. S. (2018). Association between early hyperoxia exposure after resuscitation from cardiac arrest and neurological disability: a prospective multi-center protocol-directed cohort study. Circulation, CIRCULATIONAHA-117. [PDF]
[Companion Editorial to above article] Nicole F. McKenzie, Geoffrey J. Dobb. Oxygen After Cardiac Arrest: Enough Is Enough? Circulation. 2018;137:2125-2127, originally published May 14, 2018. [Download PDF]
Page, D., Ablordeppey, E., Wessman, B. T., Mohr, N. M., Trzeciak, S., Kollef, M. H., ... & Fuller, B. M. (2018). Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study. Critical Care, 22(1), 9.
DOI: https://doi.org/10.1186/s13054-017-1926-4 [PDF]
[Companion Editorial to above article] Wepler, M., Demiselle, J., Radermacher, P., Asfar, P., & Calzia, E. (2018). Before the ICU: does emergency room hyperoxia affect outcome?. DOI: https://doi.org/10.1186/s13054-018-1980-6 [PDF]
Popović, V. V., Lesjak, V. B., Pelcl, T., & Strnad, M. (2014). Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury. Signa Vitae, 9(1), 42-46. DOI: 10.22514/SV91.042014.7 [PDF]
Helmerhorst, H. J., Schultz, M. J., van der Voort, P. H., de Jonge, E., & van Westerloo, D. J. (2015). Bench-to-bedside review: the effects of hyperoxia during critical illness. Critical care, 19(1), 284. [PDF]
Lentz, Skyler, MD & Roginski, Matthew, MD MPH. A Better Way to Treat Hypoxia. Emergency Physicians Monthly. March 9th, 2018.
All Tips: 2013 2014 2015 2016 2017 2018 - Updated! (7/16/2018)