Grensemann Jörn, Wachs Christian, Kluge Stefan
Dtsch Med Wochenschr. 2021 Jan;146(2):108-120. doi: 10.1055/a-0948-8363. Epub 2021 Jan 19.
Oxygen treatment is being widely used in intensive care and emergency medicine and is required to maintain aerobic metabolism. It may be administered by nasal cannula, face mask, high-flow therapy, and by ventilation. Under clinical circumstances, blood oxygen concentration is not relevantly increased above a partial pressure of 80 mmHg. Although oxygen therapy is often life-saving, it has recently been shown that its indiscriminate administration may increase morbidity and mortality, presumably due to a formation of reactive-oxygen species.For ventilated critically ill patients the optimal targets need to be further defined but harm has been shown for mild hyperoxia. For patients with acute exacerbation of chronic obstructive lung disease hyperoxia may lead to an increase of hypercarbia. Hyperoxia may increase myocardial necrosis in myocardial infarction. For patients with stroke, data do not show any benefit or harm from oxygen administration.On the other hand, hyperoxia shall be used for treatment in patients with cardiac arrest until return of spontaneous circulation and in patients with carbon monoxide poisoning.For other conditions, no benefit has been shown for hyperoxia, but undoubtedly, hypoxemia must be avoided, as well. Therefore, a normoxic oxygenation strategy should be employed. The optimal oxygenation targets for distinct conditions need to be further defined.
氧疗在重症监护和急诊医学中被广泛应用，是维持有氧代谢所必需的。它可以通过鼻导管、面罩、高流量治疗以及通气来给予。在临床情况下，当血氧分压高于80mmHg时，血氧浓度并不会相应增加。尽管氧疗常常能挽救生命，但最近有研究表明，不加区分地使用氧疗可能会增加发病率和死亡率，推测这是由于活性氧的形成所致。对于接受机械通气的重症患者，最佳目标仍需进一步明确，但已有研究表明轻度高氧会造成损害。对于慢性阻塞性肺疾病急性加重的患者，高氧可能会导致高碳酸血症加重。高氧可能会增加心肌梗死患者的心肌坏死。对于中风患者，目前的数据并未显示吸氧有任何益处或危害。另一方面，在心脏骤停患者恢复自主循环之前以及一氧化碳中毒患者中，应使用高氧进行治疗。对于其他情况，高氧并未显示出有益效果，但毫无疑问，也必须避免低氧血症。因此，应采用常氧合策略。不同情况下的最佳氧合目标仍需进一步明确。
