Oxygen therapy for severely ill patients can have serious side effects

Bodil Steen Rasmussen | Mai 2020 | Fastleger | Lungemedisin | Sygeplejersken |

Bodil Steen Rasmussen
Professor, chief physician, PhD,
Anaesthesia and Intensive Care,
Aalborg University Hospital

Olav Lilleholt Schjørring
Ward physician, clinical associate professor, PhD,
Anaesthesia and Intensive Care,
Aalborg University Hospital

The ongoing Covid-19 pandemic has focused on patients in need of intensive care. The number of mechanically ventilated patients has become a factor in how the pandemic is going. For the severely ill patient, oxygen therapy is a central medicine. However, too little and too much oxygen can be life-threatening. The potential side effects of oxygen therapy are thus serious. In this article chief physician Bodil Steen Rasmussen  and ward physician Olav Lilleholt Schjørring from the Anaesthesia and Intensive Care unit at Aalborg University Hospital, Denmark, reviews current evidens about oxygen therapy for severely ill adult patients.  Oxygen is vital, but… Oxygen is the basic premise of life and the fear of life-threatening oxygen deficiency in the body's cells has led to long-standing liberal oxygen therapy. Oxygen is thus the most frequently used medicine for severely ill adult patients and has so far been administered under the motto 'little oxygen is good, more oxygen is better and even more oxygen is even better'. In fact, oxygen therapy is only prescribed in half of the cases where it is given1 and most often at higher concentrations than sought.2 One explanation may be that medical oxygen is an easily accessible and inexpensive drug that can be started pre-hospital and carried anywhere in hospitals. A recently published systematic review and meta-analysis, the IOTA study, shows an increased mortality rate in liberal oxygen therapy for severely ill adult patients.3 The IOTA study's conclusion is based on 25 randomized studies with a total of 16,037 patients in a wide range of critical illness (stroke, traumatic brain injury, myocardial infarction, cardiac arrest, sepsis, intensive therapy, and emergency surgery). Leading research groups, however, argued with the publication of the IOTA study in Lancet3 for a significantly lower evidence regarding the increased mortality from liberal oxygen therapy. 4,5,5,6...