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domingo, 13 de mayo de 2018

Oxygen in the Acutely Unwell Patient

St Emlyn´s - By Simon Carley - May 13, 2018
"...Does this make sense?
Oxygen is good for you of course. Anyone who has tried to do without it will be fully aware of the challenges of hypoxia, but what’s the problem with 02 excess? This study cannot answer that question, but the discussion explores the pathophysiological argument for why an excess of 02 may be a problem for the critically unwell. In essence we know that 02 levels are a powerful driver in physiology and pathology and we also know that were never designed or evolved to have supra-normal levels as they don’t occur in nature. Vasoconstriction, inflammation and oxiditive stress have all been demonstrated in physiological models and constitute plausible mechanisms for harm. However, the discussion is more nuanced than this and I would recommend you read the full article to understand specific sub groups (e.g. surgical patients where super-oxia may be beneficial).
So what does this mean for my practice?
In Virchester it means that we will carry on as we have done recently. Superoxia is to be avoided. In a small group of patients we will tolerate superoxia (for example in the initial resus phase whilst preparing for advanced airway management, but for the vast majority of our patients an Sa02 of >94% is just fine thanks."