Oxygen Therapy: Difference between revisions

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== Risks Of Oxygen Therapy  ==
== Risks Of Oxygen Therapy  ==


'''1. Pulmonary toxicity:'''
'''1. Depression of ventilation:'''


Patients exposed to high oxygen levels for a prolonged period of time have lung damage. The extent of lung damage is dependent on FiO<sub>2</sub> and duration of exposure. It is due to intracellular free radicals (such as superoxide, activated hydroxyl ions, singlet O<sub>2</sub> and hydrogen peroxide) formed which can damage alveolar-capillary membrane. It starts with increased permeability of the capillaries with resultant edema, thickened membranes and finally to pulmonary fibrosis.
It is seen in [[COPD (Chronic Obstructive Pulmonary Disease)|COPD]] patients with chronic CO<sub>2</sub> retention who have hypoxic respiratory drive to breath<ref>Kim, V, Benditt, JO, Wise, RA, Sharafkhaneh, A. Oxygen therapy in chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society, 2008; 5(4):513-8. Doi: 10.1513/pats.200708-124ET.</ref>. Increased arterial tension to normal can lose the hypercapnoeic stimulus to maintain ventilation resulting in hypoventilation in these patients<ref>Ergan, B, Nava, S. Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations. COPD, 2017;14(3):351-366. doi: 10.1080/15412555.2017.1319918.</ref>.


'''2. Depression of ventilation:'''
'''2. Hyperbaric oxygen toxicity:'''


It is seen in COPD patients with chronic CO<sub>2</sub> retention who have hypoxic respiratory drive to breath. Increased arterial tension to normal can lose the hypercapnoeic stimulus to maintain ventilation resulting in hypoventilation in these
Long term hyperbaric O2 therapy can lead to pulmonary, optic and [[Brainstem|central nervous system]] toxicity<ref>Heyboer, M, Sharma, D, Santiago, W, McCulloch, N. Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified. Advances in Wound Care, 2017; 6(6): 210–224. doi:  10.1089/wound.2016.0718</ref>.


patients.
'''3. Fire hazard:'''
 
'''3. Hyperbaric oxygen toxicity:'''
 
Long term hyperbaric O2 therapy can lead to pulmonary, optic and central nervous system toxicity<ref>Heyboer, M, Sharma, D, Santiago, W, McCulloch, N. Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified. Advances in Wound Care, 2017; 6(6): 210–224. doi:  10.1089/wound.2016.0718</ref>.
 
'''4. Fire hazard:'''


Oxygen supports combustion of other fuels. Least level of supplemental oxygen (FIO2 greater than the 21% oxygen in ambient air)  should be administratered during laser bronchoscopy to avoid intratracheal ignition<ref>Millette, BH, Athanassoglou, V, Patel, A.  High flow nasal oxygen therapy in adult anaesthesia. Trends in Anaesthesia and Critical Care, 2018; 18: 29-33</ref>.
Oxygen supports combustion of other fuels. Least level of supplemental oxygen (FIO2 greater than the 21% oxygen in ambient air)  should be administratered during laser bronchoscopy to avoid intratracheal ignition<ref>Millette, BH, Athanassoglou, V, Patel, A.  High flow nasal oxygen therapy in adult anaesthesia. Trends in Anaesthesia and Critical Care, 2018; 18: 29-33</ref>.


'''5. Absorption atelectasis:'''
'''4. Absorption atelectasis:'''


Given only pure oxygen results in the collapse of the dependent part of the lungs as it quickly taken up from the alveoli. It is also a risk in general anaesthesia induction<ref>Hedenstierna, G, Rothen, HU. Atelectasis formation during anesthesia: causes and measures to prevent it. Jornal of clinical medicine and computing, 2000; 16(5-6):329-35.</ref>  
Given only pure oxygen results in the collapse of the dependent part of the lungs as it quickly taken up from the alveoli. It is also a risk in general anaesthesia induction<ref>Hedenstierna, G, Rothen, HU. Atelectasis formation during anesthesia: causes and measures to prevent it. Jornal of clinical medicine and computing, 2000; 16(5-6):329-35.</ref>  


'''6. Retinopathy of prematurity (ROP):'''
'''5. Retinopathy of prematurity (ROP):'''


It usually occur in  low birth weight, very premature infant. That is why in preterm infants, 50-80 mmHg PaO<sub>2</sub> is recommended in  infants receiving oxygen<ref>Saugstad, OD. Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits. Neonatology, 2018;114:69–75.DOI: 10.1159/000486751</ref>  
It usually occur in  low birth weight, very premature infant. That is why in preterm infants, 50-80 mmHg PaO<sub>2</sub> is recommended in  infants receiving oxygen<ref>Saugstad, OD. Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits. Neonatology, 2018;114:69–75.DOI: 10.1159/000486751</ref>  


'''7.''' Bacterial contamination associated with certain nebulization and humidification systems is a possible hazard<ref>La Fauci, V, Costa, GB, Facciolà, A, Conti, A, Riso, R, Squeri, R. Humidifiers for oxygen therapy: what risk for reusable and disposable devices? Journal of Preventive Medicine and Hygiene, 2017; 58: E161-E165</ref>.
'''6.''' Bacterial contamination associated with certain nebulization and humidification systems is a possible hazard<ref>La Fauci, V, Costa, GB, Facciolà, A, Conti, A, Riso, R, Squeri, R. Humidifiers for oxygen therapy: what risk for reusable and disposable devices? Journal of Preventive Medicine and Hygiene, 2017; 58: E161-E165</ref>.
 
'''7.''' Oxygen therapy is contrindicated in patients suffering from paraquat poisoning<ref>Gawarammana, IB,  Buckley, NA. Medical management of paraquat ingestion. British Journal of clinical pharmacology, 2011; 72(5): 745–757. doi:  10.1111/j.1365-2125.2011.04026.x</ref>
 
'''8. Pulmonary toxicity:'''


'''8.''' Oxygen therapy is contrindicated in patients suffering from paraquat poisoning<ref>Gawarammana, IB,  Buckley, NA. Medical management of paraquat ingestion. British Journal of clinical pharmacology, 2011; 72(5): 745–757. doi:  10.1111/j.1365-2125.2011.04026.x</ref>  
Patients exposed to high oxygen levels for a prolonged period of time have lung damage<ref>Mach, WJ, Thimmesch, AR, Pierce, JT, Pierce, JD. Consequences of Hyperoxia and the Toxicity of Oxygen in the Lung. Nursing Research and Practice,  2011.  <nowiki>http://dx.doi.org/10.1155/2011/260482</nowiki></ref>. The extent of lung damage is dependent on FiO<sub>2</sub> and duration of exposure. It is due to intracellular free radicals (such as superoxide, activated hydroxyl ions, singlet O<sub>2</sub> and hydrogen peroxide) formed which can damage alveolar-capillary membrane. It starts with increased permeability of the capillaries with resultant edema, thickened membranes and finally to pulmonary fibrosis.


'''9.''' Care should be taken in the use of oxygen in patients receiving bleomycin or have previously used it<ref>Debnath, J. Supplemental oxygen therapy in bleomycin-induced pulmonary toxicity: REPLY. Medical Journal, Armed forces India, 2011; 67(2): 194–195.  doi:  10.1016/S0377-1237(11)60037-3</ref>.
Care should be taken in the use of oxygen in patients receiving bleomycin or have previously used it<ref>Debnath, J. Supplemental oxygen therapy in bleomycin-induced pulmonary toxicity: REPLY. Medical Journal, Armed forces India, 2011; 67(2): 194–195.  doi:  10.1016/S0377-1237(11)60037-3</ref>.


== Resources  ==
== Resources  ==

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Description
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Indication
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Risks Of Oxygen Therapy[edit | edit source]

1. Depression of ventilation:

It is seen in COPD patients with chronic CO2 retention who have hypoxic respiratory drive to breath[1]. Increased arterial tension to normal can lose the hypercapnoeic stimulus to maintain ventilation resulting in hypoventilation in these patients[2].

2. Hyperbaric oxygen toxicity:

Long term hyperbaric O2 therapy can lead to pulmonary, optic and central nervous system toxicity[3].

3. Fire hazard:

Oxygen supports combustion of other fuels. Least level of supplemental oxygen (FIO2 greater than the 21% oxygen in ambient air)  should be administratered during laser bronchoscopy to avoid intratracheal ignition[4].

4. Absorption atelectasis:

Given only pure oxygen results in the collapse of the dependent part of the lungs as it quickly taken up from the alveoli. It is also a risk in general anaesthesia induction[5]

5. Retinopathy of prematurity (ROP):

It usually occur in  low birth weight, very premature infant. That is why in preterm infants, 50-80 mmHg PaO2 is recommended in  infants receiving oxygen[6]

6. Bacterial contamination associated with certain nebulization and humidification systems is a possible hazard[7].

7. Oxygen therapy is contrindicated in patients suffering from paraquat poisoning[8]

8. Pulmonary toxicity:

Patients exposed to high oxygen levels for a prolonged period of time have lung damage[9]. The extent of lung damage is dependent on FiO2 and duration of exposure. It is due to intracellular free radicals (such as superoxide, activated hydroxyl ions, singlet O2 and hydrogen peroxide) formed which can damage alveolar-capillary membrane. It starts with increased permeability of the capillaries with resultant edema, thickened membranes and finally to pulmonary fibrosis.

Care should be taken in the use of oxygen in patients receiving bleomycin or have previously used it[10].

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Kim, V, Benditt, JO, Wise, RA, Sharafkhaneh, A. Oxygen therapy in chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society, 2008; 5(4):513-8. Doi: 10.1513/pats.200708-124ET.
  2. ↑ Ergan, B, Nava, S. Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations. COPD, 2017;14(3):351-366. doi: 10.1080/15412555.2017.1319918.
  3. ↑ Heyboer, M, Sharma, D, Santiago, W, McCulloch, N. Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified. Advances in Wound Care, 2017; 6(6): 210–224. doi:  10.1089/wound.2016.0718
  4. ↑ Millette, BH, Athanassoglou, V, Patel, A.  High flow nasal oxygen therapy in adult anaesthesia. Trends in Anaesthesia and Critical Care, 2018; 18: 29-33
  5. ↑ Hedenstierna, G, Rothen, HU. Atelectasis formation during anesthesia: causes and measures to prevent it. Jornal of clinical medicine and computing, 2000; 16(5-6):329-35.
  6. ↑ Saugstad, OD. Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits. Neonatology, 2018;114:69–75.DOI: 10.1159/000486751
  7. ↑ La Fauci, V, Costa, GB, Facciolà, A, Conti, A, Riso, R, Squeri, R. Humidifiers for oxygen therapy: what risk for reusable and disposable devices? Journal of Preventive Medicine and Hygiene, 2017; 58: E161-E165
  8. ↑ Gawarammana, IB,  Buckley, NA. Medical management of paraquat ingestion. British Journal of clinical pharmacology, 2011; 72(5): 745–757. doi:  10.1111/j.1365-2125.2011.04026.x
  9. ↑ Mach, WJ, Thimmesch, AR, Pierce, JT, Pierce, JD. Consequences of Hyperoxia and the Toxicity of Oxygen in the Lung. Nursing Research and Practice,  2011.  http://dx.doi.org/10.1155/2011/260482
  10. ↑ Debnath, J. Supplemental oxygen therapy in bleomycin-induced pulmonary toxicity: REPLY. Medical Journal, Armed forces India, 2011; 67(2): 194–195.  doi:  10.1016/S0377-1237(11)60037-3
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