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

Kallet, Richard H; Branson, Richard D.

doi:10.4187/respcare.04933

Cited by 39 publications

(31 citation statements)

References 112 publications

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“…In this study, the HFNC group was used a F I O 2 of 1.0 during exercise training. Prolonged hyperoxia has been implicated in organ toxicity processes, such as acute lung injury [37][38][39]. Systemically, hyperoxia induces peripheral vasoconstriction [40] and, increases production of reactive oxygen species [41].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of High-Flow Nasal Cannula on Pulmonary Rehabilitation in Subjects with Chronic Respiratory Failure

Chihara

Tsuboi

Sumi

et al. 2020

Preprint

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Backgrounds: There are no clinical data comparing the effect of exercise training using both high fraction of inspired oxygen (FIO2) and high flow through a high-flow nasal cannula (HFNC) with that of ordinary supplemental oxygen on exercise capacity in subjects with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT). Methods: In this randomized study, 32 patients with CRF receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a FIO2 of 1.0 (HFNC group; n=16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n=16). Before and after 4 weeks of exercise training, a 6-min walking test, constant-load test, and blood sampling were performed. Results: Prior to exercise training, the endurance time of the constant-load exercise test using an HFNC was significantly longer than that reported with prescribed oxygen in daily LTOT (p=0.004) or a 6 L/min nasal cannula (p=0.0003). Following 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC versus the oxygen group (55.2±69.6 m vs. —0.5±87.3 m, respectively; p=0.04). The plasma levels of adrenaline, noradrenaline, and serum C-reactive protein were significantly decreased only in the HFNC group, after 4 weeks of exercise training. Conclusions: Despite heterogeneity in the effect among patients, exercise training using both high FIO2 and high flow through an HFNC is a potentially superior exercise training modality for CRF patients receiving LTOT.Clinical Trial Registration ― http://www.clinicaltrials.gov. Unique identifier:　NCT02804243. Registered 13 June 2016.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of High-Flow Nasal Cannula on Pulmonary Rehabilitation in Subjects with Chronic Respiratory Failure

Chihara

Tsuboi

Sumi

et al. 2020

Preprint

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“…The results of recent studies highlight the importance of clinical management strategies that prevent hypoxemia while minimizing the incidence of hyperoxemia (51). Even now, nearly 240 years after the discovery of O 2 , what constitutes the safe upper limits and duration of FiO 2 remains uncertain.…”

Section: Conservative O 2 Strategymentioning

confidence: 99%

Relationship between hyperoxemia and ventilator associated pneumonia

et al. 2017

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Previous studies suggest a relationship between hyperoxemia and ventilator-associated pneumonia (VAP). Hyperoxemia is responsible for denitrogenation phenomena, and inhibition of surfactant production, promoting atelectasis in mechanically ventilated patients. Further, hyperoxemia impairs the efficacy of alveolar macrophages to migrate, phagocyte and kill bacteria. Oxygen can also cause pulmonaryspecific toxic effect called hyperoxic acute lung injury leading to longer duration of mechanical ventilation.All these hyperoxic effects are well-known risk factors for VAP. A recent retrospective large single center study identified hyperoxemia as an independent risk factor for VAP. However, two recent randomized controlled trials evaluated the impact of conservative oxygen strategy versus a liberal strategy, but did not confirm the role of hyperoxemia in lower respiratory tract infection occurrence. In this review, we discuss animal and human studies suggesting a relationship between these two common conditions in mechanically ventilated patients and potential interventions that should be evaluated. Further large prospective studies in carefully selected groups of patients are required to confirm the potential role of hyperoxemia in VAP pathogenesis and to evaluate the impact of a conservative oxygen strategy vs. a conventional strategy on the incidence of VAP.

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“…This practice may decrease cardiac output via increased mean airway pressure and systemic vascular resistance while increasing the risk of hyperoxic lung injury. 33,34 The effect of conventional hyperventilation compared with INO has been evaluated in a prospective randomized crossover study in children (n ϭ 12) with pulmonary hypertension (pulmonary artery pressure Ͼ 25 mm Hg) following repair of congenital heart disease. 33 Measurements included cardiac output derived from hemodynamic parameters in subjects assigned to either INO or hyperventilation.…”

Section: Congenital and Acquired Cardiac Disease/post-cardiac Surgerymentioning

confidence: 99%

Inhaled Pulmonary Vasodilators: Are There Indications Within the Pediatric ICU?

Kuch

Saville²,

Sanchez‐de‐Toledo

et al. 2017

Respir Care

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Inhaled nitric oxide (INO) is only FDA-cleared for neonates (> 34 weeks gestation) with hypoxic respiratory failure-associated pulmonary hypertension. Off-label use of INO is common in the pediatric population despite a lack of evidence regarding survival benefit, questioning whether the therapy should be considered outside the neonatal period. A lack of definitive evidence combined with increasing health-care costs has led to the use of less costly inhaled prostacyclin as an alternative to INO, presenting unique patient safety concerns. We evaluate the current evidence and patient safety considerations regarding inhaled pulmonary vasodilators in the pediatric population.

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

Cited by 39 publications

References 112 publications

Effectiveness of High-Flow Nasal Cannula on Pulmonary Rehabilitation in Subjects with Chronic Respiratory Failure

Effectiveness of High-Flow Nasal Cannula on Pulmonary Rehabilitation in Subjects with Chronic Respiratory Failure

Relationship between hyperoxemia and ventilator associated pneumonia

Inhaled Pulmonary Vasodilators: Are There Indications Within the Pediatric ICU?

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