Oxygen therapy adverse effects

No therapy for advanced/decompensated heartfailure studied to date has been shown conclusively to influence mortality. Treatment goals are directed toward restoration of systemic oxygen transport and tissue perfusion, relief of pulmonary edema, and limitation of further cardiac damage. Maximizing oral therapy and using combinations of shortacting intravenous medications with different cardiovascular actions often are needed to optimize cardiac output, relieve pulmonary edema, and limit myocardial ischemia. Invasive hemodynamic monitoring usually is required to provide immediate feedback on treatment efficacy and adverse effects. 

Due to the adverse effects associated with the therapies described, many investigators advocate testing for pulmonary vascular responsiveness. The potential for reversal of pulmonary vascular resistance is assessed either by a selective pulmonary vasodilator such as acetylcholine or by a short-acting, easily titratable, nonselective vasodilator such as prostacyclin. These agents appear to be more predictive of pulmonary vascular responsiveness than administration of 100% oxygen or intravenous phenotolamine. Rozkovec et al. (1982) suggest that patients who have a greater than 20% fall in total... 

Importantly, the toxicity of bleomycin is cumulative. Total doses in excess of 450 units are associated with a significantly increased incidence of adverse lung reactions and death. The incidence of bleomycin-induced lung toxicity has been reported between 0% and 46% with a mortality rate of 3% (5,7). As mentioned above, high cumulative dose, extreme of age, uremia, the use of supplemental oxygen, and radiation therapy are well-documented risk factors for bleomycin toxicity. Other chemotherapeutic agents (cyclophosphamide and vincristine) may also have a synergistic effect with bleomycin. Finally, bleomycin may occasionally reactivate a prior radiation-induced pneumonitis, a phenomenon known as radiation-recall. ... 

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