May 17, 2018

Patricia Kritek, MD reviewing

A meta-analysis shows significantly higher mortality with liberal use of supplemental oxygen in acutely ill patients.

Supplemental oxygen can be a life-saving intervention for patients with hypoxemic respiratory failure; however, emerging evidence suggests that too much oxygen is harmful (NEJM JW Gen Med Dec 1 2016 and JAMA 2016; 316:1583). Small trials have shown excess cardiac arrhythmias, lung injuries, and other complications in hospitalized patients without demonstrated hypoxemia who receive oxygen or whose oxygen administration results in supra-normal partial pressures (i.e., hyperoxemia). Should we be doing more to turn down the oxygen when it's not needed?

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Investigators completed a meta-analysis of 25 randomized trials that included 16,000 acutely ill patients who were treated with either a liberal or a conservative oxygenation strategy. Oxygen targets and supplementation thresholds differed across studies. Median oxygen supplementation levels were fraction of inspired oxygen (FiO2) 0.52 vs. 0.21 (liberal vs. conservative).

Relative risk for death at 30 days was significantly higher in patients who received liberal oxygen (RR, 1.14), although no association was evident between mortality and either peripheral saturation or FiO21 Boutique Forever 21 Forever Boutique Cardigan 2. Risk for disability, length of stay, and incidence of hospital-acquired infections, including pneumonia, were similar under both strategies.


Forever 21 Cardigan Boutique Forever 21 Boutique All too often, a patient's oxygen saturation is maintained at 100%. This is not only unnecessary but also probably harmful. It should become part of our practice to turn down the supplemental oxygen until we see oxygen saturations no higher than 95% for most patients and to stop oxygen use as soon as it is not needed. I suspect that we will learn that a target saturation lower than 95% is safe, but for now, avoiding hyperoxemia makes sense.


Disclosures for Patricia Kritek, MD at time of publication

Speaker’s Bureau American College of Chest Physicians (Critical Care Board Review Course)
Editorial boards American Journal of Respiratory and Critical Care Medicine
Forever Forever 21 Boutique Cardigan 21 Boutique Leadership positions in professional societies American Thoracic Society (Chair of the Nominating Committee, Section on Medical Education)


Chu DK et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): A systematic review and meta-analysis. Lancet 2018 Apr 28; 391:1693. (

McEvoy JW. Excess oxygen in acute illness: Adding fuel to the fire. Lancet 2018 Apr 28; 391:1640. (Bandolino Promotion Promotion Promotion Bandolino Bandolino Bandolino Promotion Promotion Bandolino Promotion 8wqxtF7f)