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Benefits and risks of oxygen therapy during acute medical illness: Just a matter of dose!

Authors
  • Allardet-Servent, J1
  • Sicard, G2
  • Metz, V3
  • Chiche, L4
  • 1 Service de réanimation, Hôpital Européen Marseille, 6, rue Désirée Clary, 13003 Marseille, France. Electronic address: [email protected] , (France)
  • 2 Service de pharmacie, Hôpital Européen Marseille, 13003 Marseille, France; SMARTc, faculté de pharmacie, 13003 Marseille, France. , (France)
  • 3 Service de pharmacie, Hôpital Européen Marseille, 13003 Marseille, France. , (France)
  • 4 Unité de médecine interne et recherche clinique, Hôpital Européen Marseille, 13885 Marseille cedex 5, France. , (France)
Type
Published Article
Journal
La Revue de medecine interne
Publication Date
Oct 01, 2019
Volume
40
Issue
10
Pages
670–676
Identifiers
DOI: 10.1016/j.revmed.2019.04.003
PMID: 31054779
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Oxygen therapy is used to reverse hypoxemia since more than a century. Current usage is broader and includes routine oxygen administration despite normoxemia which may result in prolonged periods of hyperoxemia. While systematic oxygen therapy was expected to be of benefit in some ischemic diseases such as stroke or acute myocardial infarction, recent randomised controlled trials (RCTs) have challenged this hypothesis by showing the absence of clinical improvement. Although oxygen is known to be toxic at high inspired oxygen fractions, a recent meta-analysis of RCTs revealed the life-threatening effect of hyperoxemia, with a dose-dependent relationship. Several recommendations have therefore been updated: (i) to monitor peripheral oxygen saturation (SpO2) as a surrogate for arterial oxygen saturation (SaO2); (ii) to initiate oxygen only when the lower SpO2 threshold is crossed; (iii) to titrate the delivered oxygen fraction to maintain SpO2 within a target range; and (iv) to stop supplying oxygen when the upper limit of SpO2 is surpassed, in order to prevent hyperoxemia. The lower and upper limits of SpO2 depend on the presence of risk factors for oxygen-induced hypercapnia (Chronic obstructive pulmonary disease, asthma, and obesity-associated hypoventilation). For patients at risk, oxygen therapy should be started when SpO2 is≤88% and stopped when it is>92%. For patients without risk factors, oxygen therapy should be started when SpO2 is≤92% and stopped when it is >96%. High-flow oxygen should only be used in a few diseases such as carbon monoxide poisoning, cluster headaches, sickle cell crisis and pneumothorax. Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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