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Canadian Respiratory Journal 2017
Topics: Extracorporeal Membrane Oxygenation; Humans; Hypoxia; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Insufficiency
PubMed: 28588381
DOI: 10.1155/2017/2462818 -
Respiratory Care Jun 2017Oxygen is a colorless, odorless, tasteless gas that is utilized by the body for respiration. Oxygen has played a major role in respiratory care. Oxygen therapy is useful... (Review)
Review
Oxygen is a colorless, odorless, tasteless gas that is utilized by the body for respiration. Oxygen has played a major role in respiratory care. Oxygen therapy is useful in treating hypoxemia but is often thought of as a benign therapy. After many years of study, we have learned a great deal of the benefits and potential risk of this powerful drug. Today oxygen gas is cheap, widely available, and easy to administer. Oxygen delivery devices vary in cost from a few cents for a simple nasal cannula to $25-$50 for some humidified systems. Undoubtedly, oxygen therapy is an important tool and has saved many lives and improved others. However, oxygen therapy risk, cost, and benefits should be considered in the same way as other drugs and titrated to a measured end point to avoid excessive or inadequate dosing. Withholding oxygen can have a detrimental effect, yet continuing to provide oxygen therapy when it is no longer indicated can prolong hospitalization and increase the cost of care. This comprehensive review begins with an assessment of need and a review of physiologic effects, potential toxicities, and common delivery devices, and it ends with advances in oxygen therapy with a focus on the pediatric patient.
Topics: Administration, Inhalation; Child; Humans; Hypoxia; Oxygen; Oxygen Inhalation Therapy
PubMed: 28546370
DOI: 10.4187/respcare.05245 -
Respiratory Care Apr 2016High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver... (Review)
Review
High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F(IO2), and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.
Topics: Adult; Cannula; Critical Illness; Female; Humans; Humidity; Male; Nose; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency; Work of Breathing
PubMed: 27016353
DOI: 10.4187/respcare.04577 -
Journal of Advanced Nursing Nov 2017To determine the effects of low-flow oxygen therapy with humidified or non-humidified oxygen in adult patients. (Meta-Analysis)
Meta-Analysis Review
AIMS
To determine the effects of low-flow oxygen therapy with humidified or non-humidified oxygen in adult patients.
BACKGROUND
Although non-humidified oxygen in low-flow oxygen therapy is recommended by many guidelines, humidifying oxygen regardless of oxygen flow has been routinely performed in China and Japan and further studies are needed to evaluate the evidence.
DESIGN
A systematic review and meta-analysis that comply with the recommendations of the Cochrane Collaboration were conducted.
DATA SOURCES
Studies (1980-2016) were identified by searching PUBMED, EMBASE, Science Direct, Cochrane library, CNKI and Wanfang Database.
METHODS
We performed a comprehensive, systematic meta-analysis of randomized controlled trials on the efficacy of humidified and non-humidified low-flow oxygen therapy. Summary risk ratios or weighted mean differences with 95% confidence intervals were calculated using a fixed- or random-effects model.
RESULTS
Twenty-seven randomized controlled trials with a total number of 8,876 patients were included. Non-humidified oxygen offers more benefits in reducing the bacterial contamination of humidifier bottles, as shown by the mean operating time for oxygen administration and the respiratory infections compared with humidified oxygen therapy. No significant differences were found in dry nose, dry nose and throat, nosebleed, chest discomfort, the smell of oxygen and SpO changes.
CONCLUSIONS
The routine humidification of oxygen in low-flow oxygen therapy is not justifiable and non-humidified oxygen tends to be more beneficial. However, considering that the quality of most included studies is poor, rigorously designed, large-scale randomized controlled trials are still needed to identify the role of non-humidified oxygen therapy.
Topics: Adult; Humans; Humidity; Oxygen Inhalation Therapy
PubMed: 28440960
DOI: 10.1111/jan.13323 -
NEJM Evidence Jul 2023Oxygen Therapy Part 2: Indications and ToxicityWemple et al. continue their review of oxygen therapy, discussing the acute and chronic indications for oxygen and the... (Review)
Review
Oxygen Therapy Part 2: Indications and ToxicityWemple et al. continue their review of oxygen therapy, discussing the acute and chronic indications for oxygen and the delivery of supplemental oxygen (and its potential adverse effects and toxicity).
Topics: Oxygen Inhalation Therapy; Oxygen
PubMed: 38320167
DOI: 10.1056/EVIDra2300111 -
Intensive Care Medicine May 2019This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure.
METHODS
We performed a comprehensive search of MEDLINE, EMBASE, and Web of Science. We identified randomized controlled trials that compared HFNC to conventional oxygen therapy. We pooled data and report summary estimates of effect using relative risk for dichotomous outcomes and mean difference or standardized mean difference for continuous outcomes, with 95% confidence intervals. We assessed risk of bias of included studies using the Cochrane tool and certainty in pooled effect estimates using GRADE methods.
RESULTS
We included 9 RCTs (n = 2093 patients). We found no difference in mortality in patients treated with HFNC (relative risk [RR] 0.94, 95% confidence interval [CI] 0.67-1.31, moderate certainty) compared to conventional oxygen therapy. We found a decreased risk of requiring intubation (RR 0.85, 95% CI 0.74-0.99) or escalation of oxygen therapy (defined as crossover to HFNC in the control group, or initiation of non-invasive ventilation or invasive mechanical ventilation in either group) favouring HFNC-treated patients (RR 0.71, 95% CI 0.51-0.98), although certainty in both outcomes was low due to imprecision and issues related to risk of bias. HFNC had no effect on intensive care unit length of stay (mean difference [MD] 1.38 days more, 95% CI 0.90 days fewer to 3.66 days more, low certainty), hospital length of stay (MD 0.85 days fewer, 95% CI 2.07 days fewer to 0.37 days more, moderate certainty), patient reported comfort (SMD 0.12 lower, 95% CI 0.61 lower to 0.37 higher, very low certainty) or patient reported dyspnea (standardized mean difference [SMD] 0.16 lower, 95% CI 1.10 lower to 1.42 higher, low certainty). Complications of treatment were variably reported amongst included studies, but little harm was associated with HFNC use.
CONCLUSION
In patients with acute hypoxemic respiratory failure, HFNC may decrease the need for tracheal intubation without impacting mortality.
Topics: Cannula; Humans; Hypoxia; Oxygen; Oxygen Inhalation Therapy; Respiratory Insufficiency; Treatment Outcome
PubMed: 30888444
DOI: 10.1007/s00134-019-05590-5 -
Seminars in Fetal & Neonatal Medicine Apr 2020Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth.... (Review)
Review
Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth. Excess oxygen can cause oxidative stress and tissue injury. Preterm infants due to lung immaturity may need oxygen for successful transition at birth. Although, considerable progress has been made in the last 3 decades, optimum oxygen therapy for preterm delivery room resuscitation remains unknown. In this review, we discuss the history and physiology behind oxygen therapy in the delivery room, evaluate current literature, provide practice points and point out knowledge gaps of oxygen therapy in preterm infant at birth.
Topics: Calibration; Delivery Rooms; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Oxygen; Oxygen Inhalation Therapy; Parturition; Pregnancy; Resuscitation
PubMed: 32044281
DOI: 10.1016/j.siny.2020.101081 -
International Journal of Clinical... Oct 2016The justification of the combination of vaseline and oxygen has been subject for discussion in many hospitals. Due to the lack of evidence based data in literature, we...
The justification of the combination of vaseline and oxygen has been subject for discussion in many hospitals. Due to the lack of evidence based data in literature, we have provided recommendations from a pharmacist's perspective. The use of petroleum-based products should be avoided when handling patients under oxygen therapy. Whenever a skin moisturizer is needed for lubrication or rehydration of dry nasal passages, the lips or nose when breathing oxygen, consider the use of oil-in water creams or water-based products.
Topics: Humans; Oxygen Inhalation Therapy; Petrolatum; Pharmacists; Professional Role
PubMed: 27480983
DOI: 10.1007/s11096-016-0365-7 -
Mayo Clinic Proceedings Sep 1987Clinical applications for the use of oxygen have extended beyond the hospital setting to home therapy. In patients with hypoxemic chronic obstructive pulmonary disease,... (Review)
Review
Clinical applications for the use of oxygen have extended beyond the hospital setting to home therapy. In patients with hypoxemic chronic obstructive pulmonary disease, long-term administration of oxygen has been substantiated as beneficial in terms of improved survival, decreased hospitalization, increased exercise capability and endurance, enhanced neuropsychologic function, and alleviation of hemodynamic abnormalities. Continuous oxygen therapy with use of an ambulatory system consistently provides the greatest benefit. New developments that have facilitated home oxygen therapy are conservation methods that allow flow of oxygen only during inspiration or storage of oxygen during expiration and cosmetic improvements for concealing devices used to administer oxygen. Controlled studies are needed to determine the optimal duration and method of administration of oxygen and the selection of appropriate candidates for long-term home oxygen therapy.
Topics: Cost-Benefit Analysis; Evaluation Studies as Topic; Home Nursing; Humans; Hypoxia; Long-Term Care; Lung Diseases, Obstructive; Oxygen Inhalation Therapy
PubMed: 3114573
DOI: 10.1016/s0025-6196(12)62339-8 -
Chest Feb 2011Transtracheal oxygen therapy (TTO) has been used for long-term oxygen therapy for nearly 30 years. Numerous investigators have explored the potential benefits of TTO.... (Review)
Review
Transtracheal oxygen therapy (TTO) has been used for long-term oxygen therapy for nearly 30 years. Numerous investigators have explored the potential benefits of TTO. Those results are reviewed in this article. TTO is best viewed not as a catheter but as a program for care. This article discusses patient selection for TTO. Publications evaluating complications are reviewed. In the past, a modified Seldinger technique (MST) was used for the creation of the tracheocutaneous fistula. The rather long program required for tract maturation with MST was labor-intensive and required substantial patient education and monitoring, particularly during the immature tract phase. Minor complications were not infrequent. More recently, the Lipkin method has been used to create a surgical tract under conscious sedation with topical anesthesia. The procedure is safe and well tolerated. Transtracheal oxygen is initiated the day following the procedure. Similarly, the tract matures in 7 to 10 days rather than the 6 to 8 weeks with MST. More rapid healing time and superior tract characteristics substantially reduce complications. The TTO program tailored for the Lipkin procedure is shortened, streamlined, and much less labor-intensive. Optimal outcomes with the TTO program require a committed pulmonologist, respiratory therapist, nurse, and surgeon (for the Lipkin procedure). This article discusses new directions in the use of transtracheal gas delivery, including the management of obstructive sleep apnea. Preliminary investigations regarding transtracheal augmented ventilation are presented. These include nocturnal use in severe chronic lung disease and liberation from prolonged mechanical ventilation.
Topics: Humans; Lung Diseases; Oxygen Inhalation Therapy; Patient Selection; Research Design; Sleep Apnea, Obstructive; Time Factors; Tracheostomy
PubMed: 21285058
DOI: 10.1378/chest.10-1373