Oxygen therapy and oxygen toxicity

Annals of Emergency Medicine
P Tinits

Abstract

When oxygen therapy is warranted, the minimum effective dose generally should be given. Hypoxemic patients who have normal baseline ABG may be treated initially with an intermediate to high FiO2 in the range of 35% to 100%, depending on the severity of the respiratory distress. The majority of patients with exacerbations of COPD who are not in extremis may be given an initial FiO2 of 28%, especially if their previous response to oxygen is known. When treating patients who have chronic severe hypercapnia (eg, those requiring chronic home oxygen), the initial FiO2 should be 24% even though renal compensation of the respiratory acidosis has occurred. Further mild elevation of the PaCO2, due mainly to the V/Q mismatch that oxygen therapy induces, may be sufficient to precipitate unacceptable hypercapnia. Patients with exacerbations of COPD who are obviously in extremis, with severe hypoxemia and acidosis, should start with an FiO2 of 24% unless they are being mechanically ventilated. The severity of the hypoxemia and acidosis is more predictive for the development of CO2 narcosis and respiratory failure than is the degree of hypercapnia in these patients. The FiO2 can be increased to 28% and incrementally higher if low FiO2 is tole...Continue Reading

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Citations

Mar 1, 1993·World Journal of Surgery·B M Wolfe, P G Moore
Nov 30, 2000·Critical Care : the Official Journal of the Critical Care Forum·D R Spahn
Oct 24, 2007·The Journal of Surgical Research·Bahram RasoulianAli Khoshbaten
Nov 23, 2006·Nurse Education Today·Julie ConsidineShane Thomas
Mar 5, 2010·Renal Failure·Bahram RasoulianAli Khoshbaten
Sep 26, 2013·Renal Failure·Alireza SaadatBehzad Eynollahi
Apr 8, 2014·Respiratory Physiology & Neurobiology·P J A M van OoijP J Sterk
Dec 28, 2016·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Mario SchietromaGianfranco Amicucci
Mar 21, 2006·Current Opinion in Anaesthesiology·Barbara Kabon, Andrea Kurz
Oct 1, 1994·The American Journal of the Medical Sciences·B AkpunonuG Martin

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