Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients
Abstract There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 concentrations (FIO2), and the consecutive hyperoxaemia, i.e. supraphysiological arterial O2 tensions (PaO2), have a place during the acute management of circulatory shock. This concept is based on e...
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doaj-2152f07201ee41679d4cfb5d4e6cad902021-06-06T11:32:23ZengSpringerOpenAnnals of Intensive Care2110-58202021-06-011111910.1186/s13613-021-00872-yTarget arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patientsJulien Demiselle0Enrico Calzia1Clair Hartmann2David Alexander Christian Messerer3Pierre Asfar4Peter Radermacher5Thomas Datzmann6Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de StrasbourgInstitut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, UniversitätsklinikumKlinik Für Anästhesiologie Und Intensivmedizin, UniversitätsklinikumInstitut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, UniversitätsklinikumService de Médecine Intensive - Réanimation Et Médecine Hyperbare, Centre Hospitalier Universitaire D’AngersInstitut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, UniversitätsklinikumInstitut Für Anästhesiologische Pathophysiologie Und Verfahrensentwicklung, UniversitätsklinikumAbstract There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 concentrations (FIO2), and the consecutive hyperoxaemia, i.e. supraphysiological arterial O2 tensions (PaO2), have a place during the acute management of circulatory shock. This concept is based on experimental evidence that hyperoxaemia may contribute to the compensation of the imbalance between O2 supply and requirements. However, despite still being common practice, its use is limited due to possible oxygen toxicity resulting from the increased formation of reactive oxygen species (ROS) limits, especially under conditions of ischaemia/reperfusion. Several studies have reported that there is a U-shaped relation between PaO2 and mortality/morbidity in ICU patients. Interestingly, these mostly retrospective studies found that the lowest mortality coincided with PaO2 ~ 150 mmHg during the first 24 h of ICU stay, i.e. supraphysiological PaO2 levels. Most of the recent large-scale retrospective analyses studied general ICU populations, but there are major differences according to the underlying pathology studied as well as whether medical or surgical patients are concerned. Therefore, as far as possible from the data reported, we focus on the need of mechanical ventilation as well as the distinction between the absence or presence of circulatory shock. There seems to be no ideal target PaO2 except for avoiding prolonged exposure (> 24 h) to either hypoxaemia (PaO2 < 55–60 mmHg) or supraphysiological (PaO2 > 100 mmHg). Moreover, the need for mechanical ventilation, absence or presence of circulatory shock and/or the aetiology of tissue dysoxia, i.e. whether it is mainly due to impaired macro- and/or microcirculatory O2 transport and/or disturbed cellular O2 utilization, may determine whether any degree of hyperoxaemia causes deleterious side effects.https://doi.org/10.1186/s13613-021-00872-yHyperox(aem)iaTraumatic–haemorrhagic shockSeptic shockCardiopulmonary resuscitationTraumatic brain injuryIschaemic brain injury |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Julien Demiselle Enrico Calzia Clair Hartmann David Alexander Christian Messerer Pierre Asfar Peter Radermacher Thomas Datzmann |
spellingShingle |
Julien Demiselle Enrico Calzia Clair Hartmann David Alexander Christian Messerer Pierre Asfar Peter Radermacher Thomas Datzmann Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients Annals of Intensive Care Hyperox(aem)ia Traumatic–haemorrhagic shock Septic shock Cardiopulmonary resuscitation Traumatic brain injury Ischaemic brain injury |
author_facet |
Julien Demiselle Enrico Calzia Clair Hartmann David Alexander Christian Messerer Pierre Asfar Peter Radermacher Thomas Datzmann |
author_sort |
Julien Demiselle |
title |
Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients |
title_short |
Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients |
title_full |
Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients |
title_fullStr |
Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients |
title_full_unstemmed |
Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients |
title_sort |
target arterial po2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients |
publisher |
SpringerOpen |
series |
Annals of Intensive Care |
issn |
2110-5820 |
publishDate |
2021-06-01 |
description |
Abstract There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 concentrations (FIO2), and the consecutive hyperoxaemia, i.e. supraphysiological arterial O2 tensions (PaO2), have a place during the acute management of circulatory shock. This concept is based on experimental evidence that hyperoxaemia may contribute to the compensation of the imbalance between O2 supply and requirements. However, despite still being common practice, its use is limited due to possible oxygen toxicity resulting from the increased formation of reactive oxygen species (ROS) limits, especially under conditions of ischaemia/reperfusion. Several studies have reported that there is a U-shaped relation between PaO2 and mortality/morbidity in ICU patients. Interestingly, these mostly retrospective studies found that the lowest mortality coincided with PaO2 ~ 150 mmHg during the first 24 h of ICU stay, i.e. supraphysiological PaO2 levels. Most of the recent large-scale retrospective analyses studied general ICU populations, but there are major differences according to the underlying pathology studied as well as whether medical or surgical patients are concerned. Therefore, as far as possible from the data reported, we focus on the need of mechanical ventilation as well as the distinction between the absence or presence of circulatory shock. There seems to be no ideal target PaO2 except for avoiding prolonged exposure (> 24 h) to either hypoxaemia (PaO2 < 55–60 mmHg) or supraphysiological (PaO2 > 100 mmHg). Moreover, the need for mechanical ventilation, absence or presence of circulatory shock and/or the aetiology of tissue dysoxia, i.e. whether it is mainly due to impaired macro- and/or microcirculatory O2 transport and/or disturbed cellular O2 utilization, may determine whether any degree of hyperoxaemia causes deleterious side effects. |
topic |
Hyperox(aem)ia Traumatic–haemorrhagic shock Septic shock Cardiopulmonary resuscitation Traumatic brain injury Ischaemic brain injury |
url |
https://doi.org/10.1186/s13613-021-00872-y |
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