Whats New in the
Patient Safety World
June 2018
Too Much Oxygen
Weve done multiple
columns questioning the likely overuse of oxygen and its potential untoward
side effects, particularly in patients with stroke or myocardial
infarction who are not hypoxemic (see
list of those prior columns below).
While many studies have shown lack of benefit of oxygen in patients who are not hypoxemic, only some have suggested that the oxygen supplementation may actually be harmful. Now, a new systematic review and meta-analysis (Chu 2018) concludes that, n acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. The new review included not only studies of patients with stroke or myocardial infarction but also patients with sepsis, critical illness, trauma, or cardiac arrest, and patients who had emergency surgery. In all, the review included 25 randomized controlled trials with 16,037 total patients.
Compared with a conservative oxygen strategy, a liberal oxygen strategy (median baseline saturation of peripheral oxygen [SpO2] across trials, 96%) increased mortality in-hospital (relative risk 1.21), and at 30 days (RR 1.14), and at longest follow-up (RR 1.10). Morbidity outcomes (disability at longest follow-up, risk of hospital-acquired pneumonia, any hospital-acquired infection, and length of hospital stay) were similar between groups.
They conclude that supplemental oxygen might become unfavorable above an SpO2 range of 9496% and that these results support the conservative administration of oxygen therapy.
Some of our prior columns on potential harmful effects of oxygen:
April 8, 2008 Oxygen as a Medication
January 27, 2009 Oxygen Therapy: Everything You Wanted to Know and More!
April 2009 Nursing
Companion to the BTS Oxygen Therapy Guidelines
October 6, 2009 Oxygen
Safety: More Lessons from the UK
July 2010 Cochrane
Review: Oxygen in MI
December 6, 2011 Why
You Need to Beware of Oxygen Therapy
February 2012 More
Evidence of Harm from Oxygen
March 2014 Another
Strike Against Hyperoxia
June 17, 2014 SO2S
Confirms Routine O2 of No Benefit in Stroke
December 2014 Oxygen
Should Be AVOIDed
August 11, 2015 New
Oxygen Guidelines: Thoracic Society of Australia and NZ
November 2016 Oxygen
Tank Monitoring
November 2016 More
on Safer Use of Oxygen
October 2017 End
of the Oxygen in MI and Stroke Debate?
February 2018 Oxygen
Cylinders Back in the News
References:
Chu DK, Kim L H-Y, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018; 391(10131): 1693-1705, Published 28 April 2018
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30479-3/fulltext
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