Oxygen Toxicity
What EMS providers need to know about possible complications from oxygen administration
Never withhold oxygen from patients who are in respiratory distress or hypoxic. Oxygen is truly a lifesaving drug. During major resuscitations, such as cardiac arrest and major traumas, 100% oxygen is indicated. However, for most all other patients, consider limiting oxygen to maintain SpO2 in the 90%–95% range; this also keeps the PaO2 above 60 mm Hg.1 Research has consistently shown that oxygen’s maximum benefit is obtained when delivered in the 22%–50% range4, and its benefit is limited after 6 hours of administration.3
Neonatal patient management requires special consideration. Whenever possible, utilize room air when initiating resuscitation. Only administer oxygen when the neonate remains bradycardic after 90 seconds of resuscitation efforts.5
Summary
The administration of oxygen is safe and effective for patients who are in respiratory distress or who are hypoxic. Never feel that oxygen needs to be withheld. However, keep in mind that there are real consequences to the long term utilization of high-flow oxygen. To help prevent potential complications from oxygen administration, reach for the nasal cannula before the non-rebreather mask, and apply just enough oxygen to maintain normal saturations.
References
1. Morton PG, et al, eds., Critical Care Nursing, a Holistic Approach, 8th edition. Philadelphia, PA: Lippincott, Williams & Wilkins, 2005.
2. Des Jardins T, Burton GG. Clinical Manifestations and Assessment of Respiratory Disease, 5th edition. St. Louis, MO: Elsevier, 2006.
3. O’Connor RE, et al. Acute Coronary Syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122: S787–817, 2010.
4. Shapiro BA, et al. Clinical Application of Blood Gases, 5th Edition. St. Louis, MO: Elsevier, 1994.
5. Kattwinkel J, et al, Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122: S909–S919, 2010.
6. Ntoumenopolus G. Using titrated oxygen instead of high flow oxygen during an acute exacerbation of chronic obstructive pulmonary disease (COPD) saves lives. J Physiother 57(1):55, 2011.
7. Austin MA, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomized controlled trial. BMJ 341: c5462, 2010.
Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the performance improvement coordinator for Vitalink/Airlink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. Contact him at kcollopy@colgatealumni.org.
Sean M. Kivlehan, MD, MPH, NREMT-P, is an emergency medicine resident at the University of California San Francisco and a former New York City paramedic for 10 years. Contact him at sean.kivlehan@gmail.com.
Scott R. Snyder, BS, NREMT-P, is the EMS education manager for the San Francisco Paramedic Association in San Francisco, CA. Scott has worked on numerous publications as an editor, contributing author and author, and enjoys presenting on both clinical and EMS educator topics. Contact him at scottrsnyder@me.com.
