Always give 100% (except when it comes to oxygen)
Hot off the press: The IOTA study
"Improving Oxygen Therapy in Acute Illness" - a systematic review and meta analysis of acutely ill adults treated with either liberal or conservative supplemental oxygen therapy
The body has to maintain a constant equilibrium between oxygen deliver (DO2) and oxygen consumption (VO2)
- DO2 = determined by cardiac output, hemoglobin and spO2; to a lesser extent pao2
Important to OPTIMIZE oxygen delivery in all our patients in acute illness. But liberal and somewhat excessive oxygen supplementation is declaring itself to be harmful. Why is this?
On a molecular level free radicals are produced as a consequence of cellular respiration. These free radicals are responsible for oxidative stress, inflammation, DNA damage and cellular apoptosis
"So as aerobic organisms, we find ourselves in this paradox.. oxygen is essential for life yet inherently dangerous to our existence."
History of O2 Therapy
Georgie Holtzapple, a physician in New York, published a case report of a patient who presented with lobar pneumonia and hypoxemia
- Patients became less dyspneic, less cyanotic and went home faster
He wrote the paper "To benefit average country practitioners who had no other means about learning this valuable therapy"
Successful at disseminating the news - now we prescribe oxygen all the time
BEEM Template (Best Evidence in Emergency Medicine)
- Primary article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30479-3/fulltext
- Critical Appraisal: https://goo.gl/iWnmsi
Clinical Question: Is liberal oxygen therapy efficacious and safe relative to conservative oygen therapy in acutely ill patients?
- MORE TO COME -