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Maintain A Normal Oxygen Level Until More Evidence Is Available.
Maintain A Normal Oxygen Level Until More Evidence Is Available.
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The next area a physician can turn to is expert opinion. Experts too
will consider the principle of doing no harm, but may look to extrapolate
from other knowledge, in this case oxygen physiology. Professor Atar
recommends oxygen on these grounds, citing that the principal problem in
myocardial ischaemia is a lack of oxygen where in fact it is a lack of
blood flow. A systematic review by Farquhar and colleagues reported a
mean reduction in coronary artery blood flow of 8-29% in five studies
where oxygen was given to patients with heart disease and there was a 21-
41% increase in coronary vascular resistance and a mean reduction of 15-
27% in myocardial oxygen consumption.2 Giving oxygen to a patient with
normal haemoglobin oxygen saturation (96-98%) can increase the blood
oxygen content by only 2-4% because very little oxygen is carried in the
blood independently of haemoglobin. This small rise in blood oxygen
content cannot compensate for the reduced coronary blood flow found in all
published studies. Oxygen has similar effects on cerebral blood flow and
https://www.bmj.com/rapid-response/2011/11/02/maintain-normal-oxygen-level-until-more-evidence-available-hyperoxaemia-re 1/3
04/06/2019 Maintain a normal oxygen level until more evidence is available. Hyperoxaemia reduces coronary artery blood flow. | The BMJ
Professor Atar uses the argument that hyperbaric oxygen may reduce
complications in myocardial infarction. It is conceivable that such high
partial pressures may be beneficial in overcoming the reduction in flow,
but this cannot be extrapolated back to using normobaric oxygen for the
reasons given above. It is clear that further trials of normobaric
hyperoxaemia and hyperbaric hyperoxaemia for patients with acute
myocardial ischaemia will be required but clinicians should aim to
maintain normoxaemia until such trials have been concluded.
References:
1. O'Driscoll BR, Howard LS, Davison AG; British Thoracic Society. BTS
guideline for emergency oxygen use in adult patients. Thorax. 2008 Oct;63
Suppl 6:vi1-68
https://www.bmj.com/rapid-response/2011/11/02/maintain-normal-oxygen-level-until-more-evidence-available-hyperoxaemia-re 2/3
04/06/2019 Maintain a normal oxygen level until more evidence is available. Hyperoxaemia reduces coronary artery blood flow. | The BMJ
Competing interests:
We are the lead authors of the British Thoracic Society Guideline for emergency oxygen use in adult patients
(2008)
28 June 2010
B Ronan O'Driscoll
Consultant Respiratory Physician
Anthony G Davison, Luke S Howard
Salford Royal University Hospital. Salford M6 8HD
https://www.bmj.com/rapid-response/2011/11/02/maintain-normal-oxygen-level-until-more-evidence-available-hyperoxaemia-re 3/3