Supplementary oxygen for nonhypoxemic patients O2 much of a good thing 英文参考文献.docVIP

Iscoe et al. Critical Care 2011,15:305 /content/15/3/305 VIEWPOINT Supplementary oxygen for nonhypoxemic patients: O2 much of a good thing? Steve Iscoe *, Richard Beasley and Joseph A Fisher 1 2 3 theoretically increasing tissue oxygen delivery (DO2) assuming no reduction in tissue blood ? ow. However, oxygen causes constriction of the coronary, cerebral, renal and other key vasculatures – and if regional per- fusion decreases concomitantly with blood hyperoxyge- nation, one would have a seemingly paradoxical situation in which the administration of oxygen may place tissues at increased risk of hypoxic stress. Any tissue damage in the course of oxygen administration would plausibly be attributed to the underlying disease process. Ascribing hypoxic damage to oxygen administration is counter- intuitive and is di? cult to accept without a receptive mindset. Considering the ubiquity of oxygen therapy, the continued low threshold for its administration, and the widespread belief that its use is justi? ed and safe [2,3], we believe it is important to revisit the arguments made to justify the status quo. Abstract Supplementary oxygen is routinely administered to patients, even those with adequate oxygen saturations, in the belief that it increases oxygen delivery. But oxygen delivery depends not just on arterial oxygen content but also on perfusion. It is not widely recognized that hyperoxia causes vasoconstriction, either directly or through hyperoxia-induced hypocapnia. If perfusion decreases more than arterial oxygen content increases during hyperoxia, then regional oxygen delivery decreases. This mechanism, and not (just) that attributed to reactive oxygen species, is likely to contribute to the worse outcomes in patients given high-concentration oxygen in the treatment of myocardial in