We thank our correspondents for their valuable additional comments on our article (1). The meta-analysis by Chu et al., which was published just before our article went into print, underlines clearly that hyperoxia can be associated with increased mortality (2). On this background, the administration of oxygen without prescription has to be regarded as a particular worry and should prompt intensive training measures.
As we described in our article, specialty societies have issued clear recommendations for the target ranges for oxygen supplementation for different conditions. Future studies should investigate these target ranges and optimize them.
For the best possible treatment of our patients it is crucial to put into practice what is currently known about the negative effects of hyperoxia. For this reason we welcome and support explicitly that staff in all hospital areas are alerted to the problem of iatrogenic hyperoxia, so as to avoid unnecessary administration of oxygen leading to increases in morbidity and mortality.
Alerts can, for example, be triggered by electronic devices, such as pre-set gas monitoring alarm ranges, which go off as soon as pulse oximetry identifies an oxygen saturation (SpO2) above a certain limit, and which can be facilitated by SpO2 targets that are patient-specific and individual. Automated titration systems are promising in this setting, but no results from studies exist to date. Structured implementation is a further important building block when setting physiological SpO2 targets. This could consist, for example, of specifically training the staff immediately involved in treatment and using electronic monitoring systems (3).
Dr. med. Jörn Grensemann
PD Dr. med. Valentin Fuhrmann
Prof. Dr. med. Stefan Kluge
Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf
Conflict of interest statement
Prof. Kluge received consultancy fees from Baxter, Fresenius, and Xenios. He received reimbursement of travel and accommodation expenses as well as lecture fees from Baxter, Fresenius, Sorin, and Xenios. He received consumables for the conduct of clinical and preclinical studies from ETView Ltd and Fisher & Paykel as well as funds from Xenios.
Dr. Grensemann and Dr. Fuhrmann declare that no conflict of interests exists.
|1.||Grensemann J, Fuhrmann V, Kluge S: Oxygen treatment in intensive care and emergency medicine. Dtsch Arztebl Int 2018; 115: 455–62 VOLLTEXT|
|2.||Chu DK, Kim LH, Young PJ, 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; 391: 1693–705 CrossRef|
|3.||Helmerhorst HJ, Schultz MJ, van der Voort PH, et al.: Effectiveness and clinical outcomes of a two-step implementation of conservative oxygenation targets in critically ill patients: a before and after trial. Crit Care Med 2016; 44: 554–63 CrossRef MEDLINE|