Sauerstofftherapie in der Notfall- und Intensivmedizin

Sauerstoff ist das am häufigsten verordnete Medikament im Krankenhaus. Obwohl eine Sauerstofftherapie bei vorliegender Hypoxämie in Notfallsituationen lebensrettend ist, sind schädigende Effekte im Sinne einer Sauerstofftoxizität bei hohen Sauerstoffkonzentrationen bekannt. Dieser Artikel gibt einen Überblick über die aktuellen Empfehlungen zur Sauerstoffdosis und -verabreichung.

Abstract

Oxygen treatment is being widely used in intensive care and emergency medicine and is required to maintain aerobic metabolism. It may be administered by nasal cannula, face mask, high-flow therapy, and by ventilation. Under clinical circumstances, blood oxygen concentration is not relevantly increased above a partial pressure of 80 mmHg. Although oxygen therapy is often life-saving, it has recently been shown that its indiscriminate administration may increase morbidity and mortality, presumably due to a formation of reactive-oxygen species.

For ventilated critically ill patients the optimal targets need to be further defined but harm has been shown for mild hyperoxia. For patients with acute exacerbation of chronic obstructive lung disease hyperoxia may lead to an increase of hypercarbia. Hyperoxia may increase myocardial necrosis in myocardial infarction. For patients with stroke, data do not show any benefit or harm from oxygen administration.

On the other hand, hyperoxia shall be used for treatment in patients with cardiac arrest until return of spontaneous circulation and in patients with carbon monoxide poisoning.

For other conditions, no benefit has been shown for hyperoxia, but undoubtedly, hypoxemia must be avoided, as well. Therefore, a normoxic oxygenation strategy should be employed. The optimal oxygenation targets for distinct conditions need to be further defined.

Schlüsselwörter - O₂-Therapie - Oxygenierung - Hypoxie - Dyspnoe

Key words

O₂ therapy - oxygenation - hypoxia - dyspnea

Publication History

Article published online:
19 January 2021

• Literatur

• 1 Koehler N, Goubeaud M, Hildebrandt O. et al The history of oxygen – from its discovery to its implementation as medical therapy. Pneumologie 2011; 65: 736-741
• 2 Bornstein A. Ueber Sauerstoffvergiftung. Dtsch Med Wochenschr 1912; 43
• 3 Comroe JH, Dripps RD, Dumke PR. et al Oxygen toxicity: the effect of inhalation of high concentrations of oxygen for twenty-four hours on normal men at sea level and at a simulated altitude of 18000 feet. JAMA 1945; 128
• 4 Helmerhorst HJ, Schultz MJ, van der Voort PH. et al Bench-to-bedside review: the effects of hyperoxia during critical illness. Crit Care 2015; 19: 015-0996
• 5 Hardavella G, Karampinis I, Frille A. et al Oxygen devices and delivery systems. Breathe 2019; 15: e108-e116 . doi:10.1183/20734735.0204-2019
• 6 Grensemann J, Fuhrmann V, Kluge S. Sauerstofftherapie in der Intensiv- und Notfallmedizin. Dtsch Arztebl Int 2018; 115: 455-462 . doi:10.3238/arztebl.2018.0455
• 7 Knöller E, Stenzel T, Broeskamp F. et al Effects of hyperoxia and mild therapeutic hypothermia during resuscitation from porcine hemorrhagic shock. Crit Care Med 2016 [in press]
• 8 de Jonge E, Peelen L, Keijzers PJ. et al Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care 2008; 12: 1-8 . doi:10.1186/cc7150
• 9 Girardis M, Busani S, Damiani E. et al Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit: The Oxygen-ICU Randomized Clinical Trial. JAMA 2016; 316: 1583-1589 . doi:10.1001/jama.2016.11993
• 10 Asfar P, Schortgen F, Boisrame-Helms J. et al Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial. Lancet Respir Med 2017; 5: 180-190
• 11 [Anonym]. Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. New England Journal of Medicine 2019;
• 12 Barrot L, Asfar P, Mauny F. et al Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome. New England Journal of Medicine 2020; 382: 999-1008 . doi:10.1056/NEJMoa1916431
• 13 McNulty PH, King N, Scott S. et al Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol 2005; 288
• 14 Stub D, Smith K, Bernard S. et al Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation 2015; 131: 2143-2150
• 15 Hofmann R, James SK, Jernberg T. et al Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med 2017; 377: 1240-1249 . doi:10.1056/NEJMoa1706222
• 16 [Anonym]. S3-Leitlinie Infarktbedingter kardiogener Schock, Registrierungsnummer: 019/013. In; 2019
• 17 [Anonym]. S3-Leitlinie Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz, Registrierungsnummer: 001/021 2017.
• 18 Murphy PB, Rehal S, Arbane G. et al Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA 2017; 317: 2177-2186 . doi:10.1001/jama.2017.4451
• 19 Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care 2012; 16: 323 . doi:10.1186/cc11475
• 20 Austin MA, Wills KE, Blizzard L. et al Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ 2010; 341: c5462
• 21 Roffe C, Nevatte T, Sim J. et al Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial. JAMA 2017; 318: 1125-1135 . doi:10.1001/jama.2017.11463
• 22 Meyhoff CS, Wetterslev J, Jorgensen LN. et al Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA 2009; 302: 1543-1550
• 23 Fonnes S, Gogenur I, Sondergaard ES. et al Perioperative hyperoxia – Long-term impact on cardiovascular complications after abdominal surgery, a post hoc analysis of the PROXI trial. Int J Cardiol 2016; 215: 238-243
• 24 Abernethy AP, McDonald CF, Frith PA. et al Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet 2010; 376: 784-793 . doi:10.1016/S0140-6736(10)61115-4
• 25 Page D, Ablordeppey E, Wessman BT. et al Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study. Crit Care 2018; 22: 9 . doi:10.1186/s13054-017-1926-4
• 26 Grensemann J, Simon M, Kluge S. Atemwegsicherung in der Intensiv- und Notfallmedizin – Was gibt es Neues?. Med Klin Intensivmed Notfmed 2019; 114: 334-341 . doi:10.1007/s00063-018-0498-7