Effect of inspired oxygen fraction on alveolar derecruitment in acute respiratory distress syndrome

Abstract

In mechanically ventilated patients with ALI the breathing of pure oxygen leads to derecruitment, which is prevented by high PEEP.

Effects of ventilation with 100% oxygen during early hyperdynamic porcine fecal peritonitis*

“…Moreover, low tidal volume ventilation was lung-protective within 20 hrs of ovine fecal peritonitis (45) and in patients with acute respiratory distress syndrome despite increased FiO 2 levels (46). Furthermore, Aboab et al (47) recently demonstrated in patients with acute lung injury that high PEEP levels (about 15 cm H 2 O) together with low tidal volumes prevented alveolar derecruitment induced by 100% oxygen. Finally, the peritonitis per se may have attenuated any putative toxicity of 100% oxygen: Both reduced and increased sensitivities to hyperoxia were reported in animals challenged with lipopolysaccharide, oleic acid, and gastric juice aspiration (48 -50).…”

Efficiency of goal-directed oxygen delivery in ICU patients

“…a PaO 2 /FiO 2 ratio above 400 in a normal lung). In addition, the association between a worsened oxygen index and a high FiO 2 may not be necessarily due to direct toxicity but maybe atelectasis [21].…”

Should Oxygen Therapy Be Tightly Regulated to Minimize Hyperoxia in Critically Ill Patients?

“…Over the last decade, 8 clinical trials have attempted to evaluate the impact of oxygen targets and hyperoxemia on outcome in mechanically ventilated subjects 38,71,[88][89][90][91][92][93] along with 2 meta-analyses. 94,95 Of these, 4 have evaluated the use of so-called "conservative oxygen therapy."…”

“…In a few cases, excessive F IO 2 has been associated with absorption atelectasis and worsening gas exchange. 38,90,91 However, this typically occurs when F IO 2 ϭ 1.0, not because of need but as part of the study design. In more recent trials, there appears to be a signal related to the duration of ventilation.…”