OXYGEN IN ACUTELY ILL MAY BE HARMFUL-DR.D.K.JHA,M.D.
Oxygen therapy is a double edged sword in the care of acutely ill patients with hypoxemia and/or excessive use of accessory muscles of respiration.
It is a life saving therapy , but liberal use of it may increase mortality.
50%-80% of those receiving oxygen are exposed to excess oxygen and are at risk for hyperoxemia.
Liberal oxygen therapy may increase mortality at 30 days of hospitalization and at long term follow up according to the results of IOTA(improving oxygen therapy in acute- illness) ,study published in Lancet.
Derek K.Chu.MD and colleagues performed a systemic review and meta-analysis of studies identified using the cochrane central register of controlled trials,MEDLINE and WHO international clinical trials Registry.They included in their study,randomized clinical trials comparing coservative and liberal use of oxygen therapy in acutely ill adults.The study period was from inception to October 2017.
The study included 16037 patients in 25 randomized trials. The outcomes of study were mortality and morbidity at longest follow up.Morbidity included hospital acquired pneuminia,hospital acquired infention of any type and length of hospital stay.Assessment of these outcomes wear done using random effects meta-analysis.
The relative risk(RR) of mortality was increased in the group with liberal use of oxygen(RR 1.21) for inhospital patients,30 day mortality(RR1.41) and longest follow up(1.10).The liberal use of oxygen also failed to improve the morbidity outcomes.
According to the suggestion of authors ,supplemental oxygen might be detrimental above a peripheral saturation range of 94%-96%.
Thus oxygen therapy should be used coservatively and judisiously to save life.Over enthusiastic treatment with oxygen may endanger life rather than saving it.
REFERENCE:Chu DK,Kim LH-Y,Young PJ,et al. Mortality and morbidity in acutely ill adults treated with liberal versus coservative oxygen therapy(IOTA):a systemic review and meta-analysis.Lancet.2018;391:1693-1705