PATIENT SAFETY IN RESPIRATORY

CAER INTIATTIVE SAUDI PATIENT SAFETY CENTER

SAFETY ALERT – High Fraction of Inspired Oxygen

during Mechanical Ventilation

Observation
It has been noted that number of healthcare professionals managing mechanical
ventilation, are keeping high oxygen concentration delivered to their patients
without close monitoring and trying to wean when applicable. Unnecessary high
oxygen concentration will potentially harm the respiratory system and patient
general status.

Oxygen therapy
Oxygen therapy is an essential component of care of the critically ill patients receiving
mechanical ventilation. Normal arterial oxygen levels as measured by an arterial blood gas
range from 80 to 100 mm Hg, values under 70 mm Hg usually indicate that a patient needs
supplemental oxygen. Normal oxygen saturation levels as measured by pulse oximetry
range from 95% to 100%. Values under 90% are considered low.

Hyperoxia
Although supplemental oxygen is valuable in patients receiving mechanical ventilation,
excessive or inappropriate fractions of inspired oxygen (FiO2) can be damaging just like
any drug, it can have toxic effects. Hyperoxia is defined by significant elevations of the
partial arterial pressure of oxygen (PaO2) more than 100 mmHg. However, hyperoxia may
be acceptable for certain conditions, such as anemia, an carbon monoxide poisoning where
oxygen has problems being carried in the blood.

Complications of Hyperopia
The onset and degree of the toxicity vary with the concentration of FiO2 used and the dura-
tion of exposure. High FiO2 has been associated with several effects that include:

• Absorptive atelectasis
• Altered cardiovascular function
• Diminished lung volumes and shunting
• Bronchopulmonary dysplasia in neonates
• The retinopathy of prematurity in neonates
• Parenchymal injury and worsening of airspace disease
• Tracheobronchitis, erythema and edema of large airways
• Hypercapnia in adults with chronic obstructive pulmonary disease
PATIENT SAFETY IN RESPIRATORY
CAER INTIATTIVE SAUDI PATIENT SAFETY CENTER

Manipulating FiO2 safely

The FiO2 should be titrated to the lowest concentration required to meet oxygenation
goals, in particular those likely to be at risk of hyperoxia-induced lung injury because
of a prolonged duration of oxygen therapy, typically the aim for an arterial oxygen tension
(PaO2) between 60 and 80mmHg and arterial oxygen saturation [SaO2] approximately 90
and 95 %. Further increases in PaO2 add relatively little to the oxygen content of the blood.
But, clinical judgment should be used in selecting target oxygen saturation for an individual
patient

How to prevent oxygen toxicity during mechanical ventilation

There is no single well-defined threshold of FiO2 or duration
which defines a safe upper limit for prevention of oxygen
toxicity, although clinical experience suggests that FiO2
more than 0.6 is likely to induce oxygen toxicity. Additional
strategies to maximize oxygenation and reduce FiO2 should
be considered when FiO2 exceeds 0.6 for more than six
hours. These strategies include but not limited to:

• Prone positioning
• Recruitment maneuvers
• Optimal positive end-expiratory pressure (PEEP)

In Collabration with :