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Oxygen — Yes, it can be toxic !!
2018 British Medical Journal review of the data and clinical practice guideline
· Give O2 if SpO2 <90%
· Goal SpO2 no higher than 94%
· Goal SpO2 is then 90-94%. Higher O2 saturations can lead to WORSE outcomes in many cases.
· Give O2 if SpO2 <90%
· Goal SpO2 is then 90-94%. Higher O2 saturations can lead to WORSE outcomes in many cases.
Hyperoxia can cause:
· systemic vasoconstriction (hypertension) and increase cardiac output (1).
o But…it dilates pulmonary vessels. Opposing effects.
· May actually INCREASE infarct size in acute MI. Hyperoxia causes coronary vasoconstriction. (The O in MONA is dead!) (2,3)
o No benefit to supplemental oxygen in AMI….if you are not hypoxic to start with.
· Titrated oxygen treatment in COPD exacerbations had better outcomes than high flow oxygen. ( titrated oxygen = Nasal canula, SpO2 88-92%. High flow = O2 8-10 L/min) (3)
o Less acidosis with titrated O2 vs high flow. High flow in COPD can lead to acidosis that is correctable with reduced oxygen concentration.
o Titrated oxygen reduced death from respiratory failure 58% for all patients and 78% for COPD patients.
· Hyperoxia can depress respiratory drive. This can be dangerous in asthma, COPD, and obesity hypoventilation syndrome (5).
· systemic vasoconstriction (hypertension) and increase cardiac output (1).