Too Liberal Use of Oxygen Increases Risk of Death in Acutely Ill Adult Patients

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Too Liberal Use of Oxygen Increases Risk of Death in Acutely Ill Adult Patients

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• Angina Pectoris/MI
• Intensive Care
• Sepsis
• Stroke

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HAMILTON, Ontario -- April 27, 2018 -- Researchers have found there is such a thing as too much oxygen for acutely ill adults.

Extensive data analyses in a study published in The Lancet showed that supplemental oxygen, when given liberally to these patients, increases the risk of death without improving other health outcomes.

“Supplemental oxygen is administered to millions of acutely unwell patients around the world every day,” said senior author Waleed Alhazzani, MD, St. Joseph’s Healthcare Hamilton, and McMaster University, Hamilton, Ontario. “Despite this, there is a striking lack of definitive, high-quality evidence related to this common intervention.”

The researchers searched electronic academic databases from their inception through to October 2017 for randomised controlled trials done worldwide which compared liberal versus conservative oxygen therapy and death rates, as well as impacts on such aspects as disability, infections, and hospital length of stay.

The 25 randomised controlled trials comprised more than 16,000 adult patients with sepsis, stoke, trauma, emergency surgery, myocardial infarction or cardiac arrest.

Data analysis demonstrated that, compared with the conservative strategy, liberal administration of oxygen resulted in increased in-hospital death by 21%. Additional analyses suggested that the more supplemental oxygen patients were given, the higher their risk was for death.

The incidence of other conditions, such as infections or length of hospital stay, were similar between the 2 groups.

The researchers estimated 1 additional death for every 71 patients treated with a liberal oxygen strategy.

“Our findings are distinct from the pervasive view that liberal oxygen therapy for acute illnesses is at worst, harmless,” said Dr. Alhazzani.

“Prior practice guidelines and medical directives on oxygen therapy for acute illnesses have been inconsistent,” said first author Derek Chu, MD, McMaster University. “Our results provide much-needed clarification by showing, with high-quality evidence, that administering too much supplemental oxygen increases mortality among a broad range of acute illnesses. Currently, patients are frequently given supplemental oxygen and at excessive levels. A simple change to current practice -- being more moderate and cautious with how much oxygen is administered to acutely unwell patients -- could save lives.”

Reference: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30479-3/fulltext

SOURCE: McMaster University