Hyperoxic Acute Lung Injury

Kallet, Richard H; Matthay, Michael A.

doi:10.4187/respcare.01963

Cited by 355 publications

(360 citation statements)

References 105 publications

(217 reference statements)

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“…Ultimately, the committee recommended an approach prioritizing aims that may be at odds with one another: "ensure appropriate O 2 delivery to vital organs" and "minimize oxygen toxicity" (30). The inherent tension between these strategies is that an approach aimed at reducing the fraction of inspired oxygen (FI O2 ) and mean alveolar pressure to minimize hyperoxiainduced lung injury (18)(19)(20) and ventilator-induced lung injury, respectively, may be achieved only by tolerating subnormal oxygenation levels.…”

Section: The Case Of Arterial Oxygenation Target In Ardsmentioning

confidence: 99%

“…An oxygenation strategy that more closely approximates the normal state of health (25), combined with lower tidal volume ventilation (2) and precise oxygen titration to avoid hyperoxia (sustained FI O2 in excess of 80%) and hyperoxemia (18)(19)(20)22), has the potential to improve both short-and long-term outcomes in ARDS.…”

Section: An Alternative Approach To Oxygenation In Ards: Resetting Thmentioning

confidence: 99%

“…The trial, conducted between 1996 and 1999 and based on two pilot studies (31), protocolized an oxygenation target range of 55-80 mm Hg and an oxyhemoglobin saturation of 88-95% (2), effectively prioritizing the avoidance of oxygen toxicity (18)(19)(20). This oxygenation target range has been used extensively in subsequent ARDS clinical trials (3,5,32,33) and is advocated in the management of ARDS (34); consideration of targeting even lower levels has been discussed (21).…”

Section: The Case Of Arterial Oxygenation Target In Ardsmentioning

confidence: 99%

“…In each of these trials, an oxygenation target range of 55 to 80 mm Hg was employed to minimize oxygen toxicity and the potential excessive oxidant stress that may contribute to ARDS pathogenesis (18)(19)(20).…”

Section: Perspectivesmentioning

confidence: 99%

“…The optimal target range for arterial oxygenation in ARDS remains unknown, due in part to the challenge to maintain adequate tissue oxygenation and minimize harm (e.g., oxygen toxicity) (18)(19)(20). An approach targeted to subnormal oxygenation values (Pa O2 , 55-80 mm Hg) has emerged as a means to accomplish these aims (2,21,22).…”

mentioning

confidence: 99%

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Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

et al. 2014

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Since its original description in 1967, acute respiratory distress syndrome (ARDS) has been recognized as a devastating condition associated with significant morbidity and mortality. Advances in critical care medicine and ARDS management have led to a substantial increase in the number of ARDS survivors. Longterm cognitive impairment after critical illness is a significant public health concern. ARDS survivors frequently experience long-term cognitive impairment, as well as physical impairment, psychiatric morbidity, and reduced health-related quality of life. At present, no intensive care unit-based intervention has been proven to reduce the risk of long-term cognitive impairment after ARDS. To address the urgent need to identify strategies to preserve long-term health, investigators have advocated the measurement of short-and long-term outcomes in clinical trials. Maintaining adequate oxygen delivery to preserve organ function is of vital importance in ARDS management. The optimal target range for arterial oxygenation in ARDS remains unknown, due in part to the challenge to maintain adequate tissue oxygenation and to minimize harm, such as oxygen toxicity. An approach targeted to subnormal oxygenation values (partial pressure of arterial oxygen, 55-80 mm Hg) has emerged as a means to accomplish these aims. In this perspective, we critically evaluate this strategy from short-and long-term perspectives, with a focus on the potential long-term cognitive effects of the strategy. We conclude with a proposal to consider resetting the target range for arterial oxygenation higher (85-110 mm Hg) as a potential strategy to improve the long-term outcomes of ARDS survivors.

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Section: The Case Of Arterial Oxygenation Target In Ardsmentioning

confidence: 99%

Section: An Alternative Approach To Oxygenation In Ards: Resetting Thmentioning

confidence: 99%

Section: The Case Of Arterial Oxygenation Target In Ardsmentioning

confidence: 99%

Section: Perspectivesmentioning

confidence: 99%

mentioning

confidence: 99%

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Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

et al. 2014

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Oxygen Supplementation Among Patients in the Intensive Care Unit

Man

Straaten

Girbes

2017

JAMA

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In Reply Our Viewpoint examined the concept of birth centers and suggested a path to broader adoption in the United States through a network of hospital-affiliated birth centers, a model used in the United Kingdom.The Birthplace in England national prospective cohort study accounted for 95% of freestanding midwifery units in the United Kingdom, collecting comprehensive data across different delivery settings with high response rates. 1 We thought the generalizability of these data were stronger than available US studies. The outcomes were excellent for low-risk women and their infants and provide a strong case for hospital-affiliated outpatient birth centers.By contrast, the most comprehensive study evaluating outcomes among US birth centers comes from a voluntary registry run by the American Association of Birth Centers 2 into which birth centers voluntarily opt in or out. The study 2 included 79 birth centers, which represent approximately 25% of the freestanding birth centers in the United States. Although these data demonstrate good maternal and infant outcomes, the potential for selection bias reduces generalizability.We agree that accreditation of birth centers is essential for enhancing safe care. However, approximately two-thirds of US birth centers are not accredited, which undermines confidence in the accreditation process.Additionally, we advocate for a more robust collaboration protocol than is outlined by the Commission for the Accreditation of Birth Centers. 3 Although standards by the American Association of Birth Centers require a "transfer arrangement with a hospital," the description of such an agreement is minimal. A prearranged plan for access to acute services must exist, but no written agreement is required between the birth center and the receiving facility. The birth center does not have to provide practice protocols to collaborating physicians or hospitals unless specifically asked. The only handoff required before transfer is a call to the hospital. We envision a more collaborative process in which hospital-based physicians and birth center midwives agree and mutually create practice protocols, including conditions necessitating patient transfer and logistical arrangements for safe transfer. Such processes could lead to significantly better care for patients and enhanced hospital-based clinician support of a birth center model.

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Effect of Low-Normal vs High-Normal Oxygenation Targets on Organ Dysfunction in Critically Ill Patients

Gelissen

Grooth

Smulders

et al. 2021

JAMA

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IMPORTANCE Hyperoxemia may increase organ dysfunction in critically ill patients, but optimal oxygenation targets are unknown.OBJECTIVE To determine whether a low-normal PaO 2 target compared with a high-normal target reduces organ dysfunction in critically ill patients with systemic inflammatory response syndrome (SIRS).DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial in 4 intensive care units in the Netherlands. Enrollment was from February 2015 to October 2018, with end of follow-up to January 2019, and included adult patients admitted with 2 or more SIRS criteria and expected stay of longer than 48 hours. A total of 9925 patients were screened for eligibility, of whom 574 fulfilled the enrollment criteria and were randomized.INTERVENTIONS Target PaO 2 ranges were 8 to 12 kPa (low-normal, n = 205) and 14 to 18 kPa (high-normal, n = 195). An inspired oxygen fraction greater than 0.60 was applied only when clinically indicated.MAIN OUTCOMES AND MEASURES Primary end point was SOFA RANK , a ranked outcome of nonrespiratory organ failure quantified by the nonrespiratory components of the Sequential Organ Failure Assessment (SOFA) score, summed over the first 14 study days. Participants were ranked from fastest organ failure improvement (lowest scores) to worsening organ failure or death (highest scores). Secondary end points were duration of mechanical ventilation, in-hospital mortality, and hypoxemic measurements. RESULTS Among the 574 patients who were randomized, 400 (70%) were enrolled within 24 hours (median age, 68 years; 140 women [35%]), all of whom completed the trial. The median PaO 2 difference between the groups was −1.93 kPa (95% CI, −2.12 to −1.74; P < .001). The median SOFA RANK score was −35 points in the low-normal PaO 2 group vs −40 in the high-normal PaO 2 group (median difference, 10 [95% CI, 0 to 21]; P = .06). There was no significant difference in median duration of mechanical ventilation (3.4 vs 3.1 days; median difference, −0.15 [95% CI, −0.88 to 0.47]; P = .59) and in-hospital mortality (32% vs 31%; odds ratio, 1.04 [95% CI, 0.67 to 1.63]; P = .91). Mild hypoxemic measurements occurred more often in the low-normal group (1.9% vs 1.2%; median difference, 0.73 [95% CI, 0.30 to 1.20]; P < .001). Acute kidney failure developed in 20 patients (10%) in the low-normal PaO 2 group and 21 patients (11%) in the high-normal PaO 2 group, and acute myocardial infarction in 6 patients (2.9%) in the low-normal PaO 2 group and 7 patients (3.6%) in the high-normal PaO 2 group.CONCLUSIONS AND RELEVANCE Among critically ill patients with 2 or more SIRS criteria, treatment with a low-normal PaO 2 target compared with a high-normal PaO 2 target did not result in a statistically significant reduction in organ dysfunction. However, the study may have had limited power to detect a smaller treatment effect than was hypothesized.

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Hyperoxic Acute Lung Injury

Cited by 355 publications

References 105 publications

Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia?

Oxygen Supplementation Among Patients in the Intensive Care Unit

Effect of Low-Normal vs High-Normal Oxygenation Targets on Organ Dysfunction in Critically Ill Patients

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