Harmful Effects of Hyperoxia in Postcardiac Arrest, Sepsis, Traumatic Brain Injury, or Stroke: The Importance of Individualized Oxygen Therapy in Critically Ill Patients

The beneficial effects of oxygen are widely known, but the potentially harmful effects of high oxygenation concentrations in blood and tissues have been less widely discussed. Providing supplementary oxygen can increase oxygen delivery in hypoxaemic patients, thus supporting cell function and metabolism and limiting organ dysfunction, but, in patients who are not hypoxaemic, supplemental oxygen will increase oxygen concentrations into nonphysiological hyperoxaemic ranges and may be associated with harmful effects. Here, we discuss the potentially harmful effects of hyperoxaemia in various groups of critically ill patients, including postcardiac arrest, traumatic brain injury or stroke, and sepsis. In all these groups, there is evidence that hyperoxia can be harmful and that oxygen prescription should be individualized according to repeated assessment of ongoing oxygen requirements.

[1]  A. Abu-Hanna,et al.  Metrics of Arterial Hyperoxia and Associated Outcomes in Critical Care* , 2017, Critical care medicine.

[2]  M. Singer,et al.  Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit: The Oxygen-ICU Randomized Clinical Trial. , 2016, JAMA.

[3]  M. von Und Zu Fraunberg,et al.  Early Moderate Hyperoxemia Does Not Predict Outcome After Aneurysmal Subarachnoid Hemorrhage. , 2016, Neurosurgery.

[4]  R. Bellomo,et al.  Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study. , 2016, Resuscitation.

[5]  J. Poorolajal,et al.  Effects of Normobaric Hyperoxia in Traumatic Brain Injury: A Randomized Controlled Clinical Trial , 2016, Trauma monthly.

[6]  C. Guérin,et al.  Conservative versus liberal oxygenation targets for mechanically ventilated patients-a pilot multicenter randomized controlled trial. , 2016, Journal of thoracic disease.

[7]  R. Groeneveld,et al.  Short-term hyperoxia does not exert immunologic effects during experimental murine and human endotoxemia , 2015, Scientific Reports.

[8]  P. Asfar,et al.  Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update , 2015, Annals of Intensive Care.

[9]  Peter Cameron,et al.  Air Versus Oxygen in ST-Segment–Elevation Myocardial Infarction , 2015, Circulation.

[10]  J. Vincent,et al.  Normobaric hyperoxia alters the microcirculation in healthy volunteers. , 2012, Microvascular research.

[11]  P. Marques‐Vidal,et al.  Normobaric Hyperoxia is Associated with Increased Cerebral Excitotoxicity After Severe Traumatic Brain Injury , 2015, Neurocritical Care.

[12]  J. Vincent,et al.  How much oxygen in adult cardiac arrest? , 2014, Critical Care.

[13]  Arthur S Slutsky,et al.  Multiple System Organ Response Induced by Hyperoxia in a Clinically Relevant Animal Model of Sepsis , 2014, Shock.

[14]  E. de Jonge,et al.  Self-reported attitudes versus actual practice of oxygen therapy by ICU physicians and nurses , 2014, Annals of Intensive Care.

[15]  M. Grocott,et al.  Oxygen Therapy in Critical Illness: Friend or Foe? A Review of Oxygen Therapy in Selected Acute Illnesses , 2014 .

[16]  S. Mayer,et al.  Hyperoxia may be related to delayed cerebral ischemia and poor outcome after subarachnoid haemorrhage , 2014, Journal of Neurology, Neurosurgery & Psychiatry.

[17]  L. Svensson,et al.  DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial. , 2014, American heart journal.

[18]  M. Maltenfort,et al.  Association Between Hyperoxia and Mortality After Stroke: A Multicenter Cohort Study* , 2014, Critical care medicine.

[19]  J. Sim,et al.  The Stroke Oxygen Pilot Study: A Randomized Controlled Trial of the Effects of Routine Oxygen Supplementation Early after Acute Stroke—Effect on Key Outcomes at Six Months , 2013, PloS one.

[20]  J. Ligtenberg,et al.  Oxygen therapy for sepsis patients in the emergency department: a little less? , 2012, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[21]  K. Jeung,et al.  Association between mean arterial blood gas tension and outcome in cardiac arrest patients treated with therapeutic hypothermia. , 2014, The American journal of emergency medicine.

[22]  F. Guyette,et al.  The association between hyperoxia and patient outcomes after cardiac arrest: analysis of a high-resolution database , 2014, Intensive Care Medicine.

[23]  M. Singer,et al.  The medical use of oxygen: a time for critical reappraisal , 2013, Journal of internal medicine.

[24]  Oxygen therapy in non-intubated adult intensive care patients: a point prevalence study. , 2013, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[25]  R. Bellomo,et al.  Current oxygen management in mechanically ventilated patients: a prospective observational cohort study. , 2013, Journal of critical care.

[26]  R. Raj,et al.  Hyperoxemia and long-term outcome after traumatic brain injury , 2013, Critical Care.

[27]  J. Jallo,et al.  Significance of arterial hyperoxia and relationship with case fatality in traumatic brain injury: a multicentre cohort study , 2013, Journal of Neurology, Neurosurgery & Psychiatry.

[28]  J. Heffner.  The Story of Oxygen , 2013, Respiratory Care.

[29]  T. Rice,et al.  Hyperoxia is associated with increased mortality in patients treated with mild therapeutic hypothermia after sudden cardiac arrest* , 2012, Critical care medicine.

[30]  T. Scalea,et al.  Association between early hyperoxia and worse outcomes after traumatic brain injury. , 2012, Archives of surgery.

[31]  Peiying Liu,et al.  Effect of Hypoxia and Hyperoxia on Cerebral Blood Flow, Blood Oxygenation, and Oxidative Metabolism , 2012, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[32]  R. Bellomo,et al.  The association between early arterial oxygenation and mortality in ventilated patients with acute ischaemic stroke. , 2012, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[33]  R. Argyle,et al.  High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: a pilot randomized controlled trial. , 2012, American heart journal.

[34]  H. Bitterman,et al.  Dose-Related Effects of Hyperoxia on the Lung Inflammatory Response in Septic Rats , 2012, Shock.

[35]  Hyperoxia during septic shock--Dr. Jekyll or Mr. Hyde? , 2012, Shock.

[36]  M. Poca,et al.  Normobaric hyperoxia in traumatic brain injury: does brain metabolic state influence the response to hyperoxic challenge? , 2011, Journal of neurotrauma.

[37]  J. Parrillo,et al.  Relationship Between Supranormal Oxygen Tension and Outcome After Resuscitation From Cardiac Arrest , 2011, Circulation.

[38]  J. Hodsoll,et al.  The SOS Pilot Study: A RCT of Routine Oxygen Supplementation Early after Acute Stroke—Effect on Recovery of Neurological Function at One Week , 2011, PloS one.

[39]  R. Bellomo,et al.  Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest , 2011, Critical care.

[40]  M. Georgieff,et al.  Hyperoxia may be beneficial , 2010, Critical care medicine.

[41]  D. Angus,et al.  Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. , 2010, JAMA.

[42]  D. Davis,et al.  Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. , 2009, Journal of neurotrauma.

[43]  M. Georgieff,et al.  Hemodynamic, metabolic, and organ function effects of pure oxygen ventilation during established fecal peritonitis-induced septic shock , 2009, Critical care medicine.

[44]  N. D. de Keizer,et al.  Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients , 2008, Critical care.

[45]  E. Miller,et al.  Hyperoxia-induced signal transduction pathways in pulmonary epithelial cells. , 2007, Free radical biology & medicine.

[46]  Wolfgang M Kuebler,et al.  Hyperoxia-induced reactive oxygen species formation in pulmonary capillary endothelial cells in situ. , 2006, American journal of respiratory cell and molecular biology.

[47]  Priestley, the furious free thinker of the enlightenment, and Scheele, the taciturn apothecary of Uppsala , 2002, Acta anaesthesiologica Scandinavica.