The improper administration of oxygen endangers the patient due to increased reactive oxygen species. Use oxygen as a medicine that requires the right indication and dosage.

Oxygen is often given regardless of the patient's oxygen saturation level because it is thought to prevent worsening the disease. However, this is denied by several recent studies. Providing oxygen to patients suffering from acute diseases (including acute coronary syndrome) that is not indicated, increases mortality.

Indications and Risks of Oxygen Administration

Indications of Oxygen Administration

Oxygen therapy is the administration of oxygen with a higher concentration than the surrounding air to improve or prevent hypoxia symptoms and manifestations. This administration can be performed by using nasal cannulae, simple masks, non-rebreathing masks. The purpose of oxygen therapy is to treat and prevent hypoxemia, which causes tissue hypoxia that leads to tissue damage or cell death. However, improper giving of indications will only cause the opposite effect.

Indications of oxygen therapy:

  • Hypoxemia: decrease in PaO2 in the blood below normal values. PaO2 <60 or SaO2 <90% in patients breathing room air, or with PaO2 and or SaO2 below the chilled value in specific clinical situations
  • Short-term therapy such as carbon monoxide poisoning or recovery after anesthesia
  • Pneumothorax absorption
  • Shortness of breath (respiration rate above 20 x / min) with normal oxygen saturation
  • Patients have risks for tissue hypoxia (such as patients with metabolic acidosis or sepsis).

Indication of Oxygen if Oxygen Saturation Cannot Be Determined

One indication of oxygen therapy is an acute state of hypoxia. Hypoxia is generally assessed by pulse oximetry or by blood gas analysis. However, if both are not available or difficult, hypoxia can be suspected from the symptoms and signs of history taking and physical examination.

Symptoms and signs of hypoxia:
  • Neurological manifestations (restlessness, anxiety, confusion, seizures or coma)
  • Cyanosis
  • Tachypnea and dyspnea

Effects of Inappropriate Oxygen Therapy

Giving excessive oxygen therapy and not according to indications can cause hyperoxemia, increasing the number of reactive oxygen species (ROS). This increase in ROS will cause oxidative stress, which causes damage to cell death. This condition causes adverse effects in patients as follows:

Extend Hospitalization
Patients treated in ICU given oxygen reached the target of 94-98% compared to patients with a target of 97-100%, apparently with a more extended stay of> 3 days in patients with lower targets.
Worsening Disease
Hyperoxemia can cause vasoconstriction of the heart arteries. Giving excess oxygen to acute infarction can cause oxygen delivery to the heart muscle to be disrupted. The provision of high-flow oxygen can cause increased disturbance of reperfusion, the extent of infarction, and mortality in acute myocardial infarction. It is also thought to be similar in cerebral blood flow in stroke. 
Increase Mortality
Mortality is increased in oxygen administration after cardiac arrest, acute stroke, trauma to the brain, acute myocardial infarction, postneonatal resuscitation, and patients with critical conditions without hypoxia.

Target Oxygen Therapy

Providing oxygen should be given at the appropriate dose to be precise on its purpose (hypoxemia management). Oxygen saturation in healthy people is generally around 96-98%, but oxygen therapy is often given even when saturation reaches 100%.

According to the Thoracic Society of Australia and New Zealand (2015), the recommended oxygen saturation target is 92-96% in patients with acute conditions and 88-92% in patients with chronic respiratory failure. In contrast to the British Thoracic Society (2017) recommendations, the SaO2 target reaches 94-98% in almost all patients with acute disease. However, this is disproved by recent research, which finds that patients with SaO2 above 94-96% have higher mortality rates without increasing patient outcomes. At oxygen saturation <92%, it increases mortality, with the highest increase in oxygen saturation <90%. Oxygen saturation levels have no increased risk of mortality > 92%.

According to a recent study, the recommendation is target oxygen saturation at 88-92% in patients with chronic respiratory failure and hypercapnia respiratory failure, and 92-96% in other conditions. Lower the oxygen dose if saturation exceeds 96% and stop if SaO2 has reached its target without the aid of oxygen supplementation.

Giving oxygen that is not according to indications will cause danger to patients, namely prolonging hospitalization, worsening the course of the disease, to cause mortality. Indications for oxygen are hypoxemia or special conditions such as pneumothorax and carbon monoxide poisoning.

Oxygen is given until the therapeutic target is reached. Based on the latest recommendations, the recommended therapeutic target is 92-96% oxygen saturation, except in conditions of chronic respiratory failure and hypercapnic respiratory failure that require a lower therapeutic target, 88-92%. However, this target recommendation must also be adjusted to the patient's condition (such as bronchiolitis) the recommended treatment target is oxygen saturation above 90%. Make sure oxygen is treated as medicine, which requires a clear indication and dosage.