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Bench-to-bedside review: the effects of hyperoxia during critical illness

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Abstract

Oxygen administration is uniformly used in emergency and intensive care medicine and has life-saving potential in critical conditions. However, excessive oxygenation also has deleterious properties in various pathophysiological processes and consequently both clinical and translational studies investigating hyperoxia during critical illness have gained increasing interest. Reactive oxygen species are notorious by-products of hyperoxia and play a pivotal role in cell signaling pathways. The effects are diverse, but when the homeostatic balance is disturbed, reactive oxygen species typically conserve a vicious cycle of tissue injury, characterized by cell damage, cell death, and inflammation. The most prominent symptoms in the abundantly exposed lungs include tracheobronchitis, pulmonary edema, and respiratory failure. In addition, absorptive atelectasis results as a physiological phenomenon with increasing levels of inspiratory oxygen. Hyperoxia-induced vasoconstriction can be beneficial during vasodilatory shock, but hemodynamic changes may also impose risk when organ perfusion is impaired. In this context, oxygen may be recognized as a multifaceted agent, a modifiable risk factor, and a feasible target for intervention. Although most clinical outcomes are still under extensive investigation, careful titration of oxygen supply is warranted in order to secure adequate tissue oxygenation while preventing hyperoxic harm.

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Abbreviations

DAMP:

Damage-associated molecular pattern molecule

FiO2 :

Fraction of inspired oxygen

HIF:

Hypoxia-inducible factor

ICU:

Intensive care unit

PaO2 :

Partial pressure of arterial oxygen

PMN:

Polymorphonuclear neutrophil

ROS:

Reactive oxygen species

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Acknowledgments

For the preparation of Fig. 1, the creative support of Iris Levert is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, The Netherlands

    Hendrik J. F. Helmerhorst, Evert de Jonge & David J. van Westerloo

  2. Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

    Hendrik J. F. Helmerhorst & Marcus J. Schultz

  3. Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

    Marcus J. Schultz

  4. Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, Amsterdam, 1091 AZ, The Netherlands

    Peter H. J. van der Voort

  5. TIAS School for Business and Society, Tilburg University, Warandelaan 2, Tilburg, 5000 LE, The Netherlands

    Peter H. J. van der Voort

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  1. Hendrik J. F. Helmerhorst
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  2. Marcus J. Schultz
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  3. Peter H. J. van der Voort
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  4. Evert de Jonge
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  5. David J. van Westerloo
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Correspondence to Hendrik J. F. Helmerhorst.

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Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

HJFH participated in study conception and drafted the manuscript. MJS and PHJvdV participated in the interpretation and critical revision of the article for important intellectual content. EdJ and DJvW participated in study design, interpretation, and critical revision. All authors read and approved the final manuscript.

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Helmerhorst, H.J.F., Schultz, M.J., van der Voort, P.H.J. et al. Bench-to-bedside review: the effects of hyperoxia during critical illness. Crit Care 19, 284 (2015). https://doi.org/10.1186/s13054-015-0996-4

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