Hyperoxia in the management of respiratory failure: A literature review

Abstract

Management of respiratory failure is closely related to oxygen supplementation. Thus, its administration needed special attention according to indications to avoid the toxic effect. Oxygen supplementation in conditions of respiratory failure aims to overcome hypoxemia. Excessive oxygen exposure can cause oxygen toxicity and lead to hyperoxia. Hyperoxia is a condition in which there is an excess supply of oxygen in the tissues and organs. Clinically, respiratory failure is diagnosed if the PaO2 is less than 60 mmHg with or without an increase in carbon dioxide when the patient breathes room air. Respiratory failure is divided into acute (sudden) respiratory failure and chronic (slow) respiratory failure. The basis for managing respiratory failure consists of supportive/non-specific and causative/specific management. Oxygen should be prescribed wisely not to cause injury to organs such as the heart, lungs, eyes, nervous system, and others. Hyperoxia often occurs in managing respiratory failure, so it requires supervision, especially in administering oxygen. Oxygen should be given as needed to avoid hyperoxia. In oxygen therapy, it is necessary to pay attention to the patient's condition because each condition requires different oxygen concentrations, so dose adjustments are necessary. These conditions can be divided into critical, severe, and observation conditions. The target oxygen saturation in all these conditions is 94-98%.

Keywords: Hyperoxia; Oxygen; Respiratory failure; Toxicity.

Fig. 1

Relationship of PaO2 concentration to organ [22].

Fig. 2

Stages of reducing oxygen to water [11].

Fig. 3

Schematic diagram illustrating the effects of NF-κB under hyperoxia conditions [29].

Fig. 4

Mechanism of hyperoxia causing ALI (Acute Lung Injury) and BPD (Bronchopulmonary Dysplasia) [29].

Fig. 5

Initial mechanism of hyperoxia [10].

Fig. 6

Mechanisms of ROS regulation and cell death pathways due to hyperoxia [10].