Acute oxygen therapy

Rusyniak DE, Kirk MA, May JD, Kao LW, Brizendine EJ, Welch JL, Cordell WH, Alonso RJ. Hyperbaric oxygen therapy in acute ischemic stroke results of the hyperbaric oxygen in acute ischemic stroke trial pilot study. Stroke 2003 34 571-574. 

Singhal AB, Benner T, Roccatagliata L, Koroshetz WJ, Schaefer PW, Lo EH, Buonanno FS, Gonzalez RG, Sorensen AG. A pilot study of normobaric oxygen therapy in acute ischemic stroke. Stroke 2005 36 797-802. 

Oxygen therapy should be continued indefinitely if it was initiated while the patient was in a stable state (rather than during an acute episode). Withdrawal of oxygen because of improved Pao2 in such a patient may be detrimental. 

Cluster headache responds to many of the same treatment modalities used in acute migraine however, initial prophylactic therapy is required to limit the frequency of recurrent headaches within a periodic series. A novel therapy specific to cluster headaches is the administration of high-flow-rate oxygen 100% at 5 to 10 L/minute by non-rebreather facemask for approximately 15 minutes.42 If pain is not aborted, then retreatment is indicated. No side effects are seen with short-term oxygen use. If oxygen therapy is not wholly effective, then pharmaceuticals... 

Patients with acute chest syndrome should receive incentive spirometry appropriate fluid therapy broad-spectrum antibiotics including a mac-rolide or quinolone and, for hypoxia or acute distress, oxygen therapy. Steroids and nitric oxide are being evaluated. 

In a patient with chronic respiratory acidosis (e.g., chronic obstructive pulmonary disease), treatment is essentially similar to that for acute respiratory acidosis with a few important exceptions. Oxygen therapy should be initiated carefully and only if the Pao2 is less than 50 mm Hg because the drive to breathe depends on hypoxemia rather than hypercarbia. 

Patients with acute severe asthma should receive supplemental oxygen therapy to maintain arterial oxygen saturation above 90% (above 95% in pregnant women and patients with heart disease). Significant dehydration should be corrected urine specific gravity may help guide therapy in young children, in whom assessment of hydration status may be difficult. 

High concentration oxygen therapy is reserved for a state of low PaOj in association with a normal or low PaCO (type I respiratory failure), as in pulmonary embolism, pneumonia, pulmonary oedema, myocardial infarction, and young patients with acute severe asthma. Concentrations of up to 100% may be used for short periods, since there is little risk of inducing hypoventilation and CO retention. 

Treatment of the acute disease includes bed rest, oxygen therapy, mechanical ventilation when needed, and corticosteroids. Chelation has been used to treat beryllium toxicity however, no one agent is recommended over another. Aurin tricarboxylic acid has been used to protect primates from beryllium overdose, but human trials have not been conducted. 

Acute inhalation or aspiration of ingested aliphatic or aromatic petroleum hydrocarbons of low viscosity can lead to pulmonary irritation and hydrocarbon pneumonia, an acute hemorrhagic necrotizing disease. To counteract secondary bacterial infections and pulmonary edema, antibiotics and oxygen therapy are often applied when indicated by symptoms in particular patients (Klaassen... 

Meyer, G.W., Hart, G.B., and Strauss, M.B., Hyperbaric oxygen therapy for acute smoke inhalation injuries. Postgrad. Med., 89, 221-223, 1991. 

The treatment of respiratory acidosis is dependent on the chronicity of the patient s condition. Respiratory decompensation in patients with chronic elevations in PaC02 are frequently seen in those with acute infections and those recently started on narcotic analgesics or oxygen therapy. Aggressive treatment of these conditions can offer considerable benefit and should be initiated. Furthermore, tranquilizers and sedatives should be avoided and supplemental oxygen, if used, should be minimized. 

Almost all otherwise healthy babies with bronchiolitis can be followed as outpatients. Such infants are treated for fever, provided generous amounts of oral fluids, and observed closely for evidence of respiratory deterioration. In severely affected children, the mainstays of therapy for bronchiolitis are oxygen therapy and intravenous fluids. In a subset of patients, aerosolized bron-chodilators may have a role. In selected infants, particularly those with underlying pulmonary or cardiac disease or both, with severe acute infection, therapy with the antiviral agent ribavirin may be considered. 

Termination of exposure by physical removal of the casualty or use of a mask is a vital first measure. Rest is important as any physical exertion shortens the latent period and increases the severity of symptoms. The airways need to be kept clear and the circulation checked for hypotension. Bronchospasm is treated with bron-chodilators. Positive airway pressure may be required. Oxygen therapy is indicated to treat hypoxia and intubation may also be required, hi the absence of a bacterial infection, the toxic effects of low to moderate exposures to phosgene wiU be relatively short-lived with proper respiratory monitoring in place. Exposure to moderate to high concentrations of phosgene may result in acute respiratory distress and death. 

Dixon SR, Bartorelli AL, Marcovitz PA, et al. Initial experience with hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction results of a pilot study utilizing intracoronary aqueous oxygen therapy. J Am Coll Cardiol 2002 39 387-392. 

The helmet consists of a transparent PVC hood secured by two armpit braces at two hooks (one anterior and the other posterior) on a metallic ring that joins the helmet with a soft collar. The helmet was designed to deliver a precise, inspired oxygen fraction during hyperbaric oxygen therapy but has recently been utilized for NIV in acute patients, on a short-term basis. Helmets are not suited for LTMV. 

Gundavarapu, S., Zhuang, J., Barrett, E.G., et al., 2014. A critical role of acute bronchoconstriction in the mortality associated with high-dose sarin inhalation effects of epinephrine and oxygen therapies. Toxicol. Appl. Pharmacol. 274, 200-208. 

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