Revisited Hyperoxia Pathophysiology in the Perioperative Setting: A Narrative Review

Busani, Stefano; Sarti, Marco Donati; Serra, Francesco; Gelmini, Roberta; Venturelli, Sophie; Munari, Elena; Girardis, Massimo

doi:10.3389/fmed.2021.689450

Cited by 6 publications

(4 citation statements)

References 71 publications

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“…Moreover, hyperoxia may induce vasoconstriction and a reduction of cerebral blood flow velocities [ 16 ]. Further mechanisms leading to negative effects have been proposed, such as direct mitochondrial damage, triggering of neuroinflammation, or blood–brain barrier breakdown, besides extracerebral manifestations, such as pulmonary toxicity or a coronary vasoconstriction [ 17 ]. Clinically, oxygen toxicity may trigger neurologic symptoms, e.g., nausea, dizziness, or convulsions [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Hyperoxia is Dose-Dependently Associated with an Increase of Unfavorable Outcomes in Ventilated Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study

et al. 2022

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Background Adequate oxygenation in patients with aneurysmal subarachnoid hemorrhage (SAH) is imperative. However, hyperoxia increases formation of reactive oxygen species and may be associated with a dose-dependent toxicity. We postulated a threshold for arterial partial pressure of oxygen (paO2) above which toxicity effects precipitate and sought to study the effects on 30-day mortality, favorable outcome at discharge and at 3 months, and delayed cerebral ischemia. Methods In this retrospective single-center cohort study, patients with SAH and mechanical ventilation > 72 h were included. Oxygen integrals were calculated above the following thresholds: 80, 100, 120, and 150 mm Hg and time-weighted mean paO2. All calculations were done from admission to end of day 1, day 3, and day 14. We conducted multivariable logistic regression analyses adjusted for age, sex, duration of ventilation, and Hunt and Hess grade. Time-weighted mean paO2 was categorized by quartiles. Favorable outcome was defined as Glasgow Outcome Scale scores of 4 and 5. Results From November 2010 to February 2021, 282 of 549 patients fulfilled the inclusion criteria. Odds ratios for 30-day mortality increased dose dependently and were as follows: 1.07 (95% confidence interval [CI] 1.03–1.11; p = 0.001) for each 1 mm Hg per day above 80 mm Hg; 1.16 (95% CI 1.07–1.27), above 100 mm Hg; 1.36 (95% CI 1.15–1.61), above 120 mm Hg; and 1.59 (95% CI 1.22–2.08), above 150 mm Hg (all p < 0.001) at day 14. For favorable outcome at 3 months, odds ratios were 0.96 (95% CI 0.92–0.99) for each 1 mm Hg per day above 80 mm Hg; 0.90 (95% CI 0.84–0.98), above 100 mm Hg; 0.83 (95% CI 0.72–0.97), above 120 mm Hg; and 0.77 (95% CI 0.61–0.97), above 150 mm Hg (all p < 0.05). For time-weighted mean paO2, lowest 30-day mortality and highest favorable outcome at 3 months were found in the second quartile (78–85 mm Hg). Thirty-day mortality increased above 93 mm Hg (fourth quartile), with an odds ratio of 3.4 (95% CI 1.4–8.4, p = 0.007). Odds ratios for favorable outcome at 3 months were 0.28 (95% CI 0.12–0.69), 0.27 (95% CI 0.11–0.67), and 0.24 (95% CI 0.10–0.59) for the first, third, and fourth quartiles, respectively (all p < 0.01). No significant association was found at day 1 and day 3, for favorable outcome at discharge, or for delayed cerebral ischemia. Conclusions Integrals above the defined paO2 thresholds were dose-dependently associated with an increase in mortality in ventilated patients with SAH. When we considered time-weighted mean paO2, unfavorable outcomes and 30-day mortality were more frequent both below and above a certain range. Unfavorable outcomes increased in paO2 ranges usually defined as normoxia. This emphasizes the necessity to further characterize oxygenation thresholds in ventilated patients with SAH in prospective clinical studies.

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Section: Discussionmentioning

confidence: 99%

Hyperoxia is Dose-Dependently Associated with an Increase of Unfavorable Outcomes in Ventilated Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study

et al. 2022

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“…Takođe, postoji kiseonik-zavisni mehanizam koji ima uticaja na proces zaceljivanja rana. Fiziološka reakcija organizma na hiruršku traumu je edem rane koji je objašnjen poremećajima u mikrocirkulaciji zbog disekcije supkutanih krvnih sudova i nakupljanja različitih mikroelemenata u rani (trombociti, faktori koagulacije, faktori rasta, polimorfonukleari, limfociti i makrofagi) 21,22 . Naročito neutrofili zahtevaju veće količine kiseonika za svoje metaboličke aktivnosti.…”

Section: Efekti Kiseonika Na Druge Organeunclassified

When does the oxygen cease to be a remedy?

Stevanović,

Mandraš,

Krunić

2023

Galenika Med J

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Oxygen has been considered a potentially life-saving drug in life-threatening situations for decades. It is crucial in the perioperative period, where it is used daily by millions of surgical patients of all ages. Iatrogenic hyperoxia is as damaging as hypoxia, especially in young children and neonates. There is a growing awareness about this problem. Significant discoveries about the effect of oxygen on oxidative stress and cellular damage due to oxygen intoxication must contribute to developing hyperoxia monitoring, oxygen dosing guidelines, and revising the safe limits of hyperoxia. The consequences of hyperoxia can be irreversible damage to the vulnerable organs (lungs and brain), which mainly affects developing organisms.

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“…High systemic oxygen supply could induce oxidative stress with inflammation, vasoconstriction, impaired microcirculation and organ dysfunction. 11 Consequently, PaO 2 within a range of normality should be maintained at all times. However, the 'range of normality' includes upper and lower limits.…”

mentioning

confidence: 99%

“…The risks and potential harm of high-dose oxygen administration in term and preterm neonates have been pointed out in several publications. High systemic oxygen supply could induce oxidative stress with inflammation, vasoconstriction, impaired microcirculation and organ dysfunction 11 . Consequently, P aO 2 within a range of normality should be maintained at all times.…”

mentioning

confidence: 99%