Oxygen therapy, or supplemental oxygen, has become noticeably widespread medical treatment since the last century, extending from inpatient to outpatient facilities and even individual use. This therapy is primarily applied for chronic obstructive pulmonary disease (COPD), cystic fibrosis, and complications caused by hypoxia. It can also be employed for maintaining the normal level of blood oxygen or in the cases of cluster headaches and carbon monoxide toxicity. Moreover, clinicians administrate supplemental oxygen to individuals with acute diseases such as anaphylaxis, resuscitation, active convulsions, among others. For these needs, oxygen can be delivered via various devices such as the Hudson mask, Venturi masks, nasal cannula, non-invasive (NIV) and invasive ventilation, and hyperbaric chamber. However, it is worth noting that oxygen therapy sometimes can be accompanied by different complications and adverse events when used inappropriately or in excessive amounts.
Considering the therapy’s increased application in world contexts, especially due to COVID-19 that is often accompanied by dyspnea and hypoxemia, it is relevant to investigate the risk for adverse events caused by oxygen delivery devices. Furthermore, healthcare providers should be aware of actual and practical interventions that help prevent side effects and improve the quality and safety of care overall.
The Methods Used
The search for literature was conducted using the Internet, primarily Google Scholar, taking into account the most reliable sources, including professional books, government and international websites, and peer-reviewed journals that contain the most recent data. In particular, the periodicals include The Lancet, PLoS One, British Medical Journal, and others, and the preference was given for a systematic review or meta-analysis. In addition, while searching, different key terms have been utilized, such as oxygen therapy, supplemental oxygen, Hyperbaric oxygen therapy, oxygen delivery devices, nasal cannula, etcetera.
The application of oxygen therapy has increased, especially in the current century. For example, concerning COPD, the rates demonstrated growth from 33.7 percent to 40.5 percent between 2001 and 2010 (Nishi et al., 2015). Besides, in the United Kingdom, supplemental oxygen is used for about 34 percent of patients in ambulances, 25 percent in emergency departments, and 15 percent in hospitals, according to the recent literature review (Chu et al., 2018). The use of oxygen therapy is expected to grow because of the waves of the COVID-19 pandemic.
Despite its evident benefits in improving morbidity and mortality rates, superfluously high oxygen concentrations can cause severe oxygen toxicity. 50-85 percent of patients are subjected to excessive oxygen consumption, usually resulting in lung damage, respiratory failure, reduced cardiac output, hypoxic drive, inflammatory cytokine production, absorption atelectasis, or cerebral and coronary vasoconstriction (Chu et al., 2018). Additionally, Chu et al. (2018) indicate that a liberal oxygen approach typically raised in-hospital mortality compared to a conservative oxygen strategy. Hyperbaric oxygen therapy (HBOT), the most advanced therapy, can also lead to confinement anxiety and barotrauma, but their frequency is shallow.
Another literature review states that NIV may be connected with facial skin breakdown and discomfort occurring because of the inability to eat or communicate during therapy (Rochwerg et al., 2019). In addition, the study specifies that the use of high flow nasal cannula (HFNC), a type of NIV, is considerably safer but may also cause fatigue, septic shock, cardiac dysrhythmia, or nosocomial pneumonia. The Hudson mask and Venturi masks are associated with bruises and dents on the face, a dry nose, and some pulmonary complications rarely encountered in medical practice. Invasive ventilation complications can also include throat’s or trachea’s injuries since the tube through which oxygen is provided can cause irritation or scratches. It is worth noting that most incidents stem from the fact that many medical professionals consider oxygen therapy safe, exclusively beneficial, or even harmless, irrespective of the amount of delivered oxygen. Besides, occasionally, nosocomial infections are spread due to non-compliance by medical staff and patients with best hygiene practices.
Finally, long-term oxygen therapy (LTOT) can inflict significant fire hazards since a concentrated volume of oxygen facilitates fast combustion. Explosion danger exists when fuels and concentrated oxidants are placed in close proximity. Moslander et al. (2020) revealed that patients who receive LTOT and continue smoking are exposed to a higher risk of fire-associated incidents than non-smokers. Herewith, hazards include obtaining severe physical and mental injuries, a loss of limbs, and even death.
Interventions regarding the correct application of oxygen therapy and related devices differ depending on conditions. Siemieniuk et al. (2018) recommend the maximum oxygen saturation of 96 percent and starting to use oxygen therapy from the point of 92 percent. Besides, researchers state that this level should be utilized mostly for acutely ill surgical patients and be restricted for patients with carbon monoxide poisoning, cluster headaches, sickle cell crisis, and pneumothorax. Doyle and McCutcheon (2015) firmly recommend healthcare providers reminding patients that they should not use oxygen or adjust the dose without consultation with respiratory therapists or physicians. They also indicate that it is better to avoid supplemental oxygen for persons receiving bleomycin or with herbicide poisoning because of the higher risk of oxygen toxicity.
Oxygen therapy should also be administered cautiously to individuals with a hypoxic drive because they can experience hypoventilation or apnea. However, medical professionals should not deprive patients of oxygen in case it is clinically prescribed. A high concentration of oxygen should be carefully monitored through specific assessments, especially arterial blood gas tests and pulse oximetry (Doyle and McCutcheon, 2015). Monitoring is vital since a high concentration of oxygen can displace nitrogen in the alveoli, which can result in nitrogen washout and alveoli’ closure accordingly. Additionally, oxygen cylinders should be stored upright, fixed, or in respective holders to prevent occasional falls. Oxygen delivery systems should also be preserved away from any heat source at a distance of at least 1.5 meters (Doyle and McCutcheon, 2015). Smoking is prohibited nearby oxygen delivery devices in the home and hospital settings. Finally, patients and clinical staff should ensure the serviceability of electrical equipment as a minor electrical spark can lead to a massive fire with the subsequent explosion of oxygen devices.
In summary, this research paper has in-depth examined the risk for adverse events caused by oxygen delivery devices and offered practical interventions that help prevent side effects and improve care safety. After a thorough literature review, adverse events are primarily related to oxygen toxicity that leads to lung damage, respiratory failure, reduced cardiac output, hypoxic drive, and other disorders. Besides, oxygen therapy can be accompanied by physical harm, such as bruises and dents on the face, a dry nose, throat’s or trachea’s injuries, fatigue, or headache. The injuries also can be caused by the accidental ignition of objects placed near oxygen delivery devices, especially cigarettes or electrical sparks. The best way to avert these incidents is to adhere to guidelines on oxygen therapy, hygiene practice, and safety rules in the home and medical environments.
Chu, D. K., Kim, L. H., Young, P. J., Zamiri, N., Almenawer, S. A., Jaeschke, R., Szczeklik, W., Schünemann, H., Neary, J., & Alhazzani, W. (2018). Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): A systematic review and meta-analysis. The Lancet, 391(10131), 1693-1705. Web.
Doyle, G. R., & McCutcheon, J. A. (2015). Clinical procedures for safer patient care. British Columbia Institute of Technology.
Moslander, C., Lat, T., Giri, B., Pattison, R., Coppin, J., & Bhat, U. (2020). Long-term oxygen therapy and risk of fire-related events. Federal Practitioner, 37(10), 442-446. Web.
Rochwerg, B., Granton, D., Wang, D. X., Helviz, Y., Einav, S., Frat, J. P., Mekontso-Dessap, A., Schreiber, A., Azoulay, E., Mercat, A., Demoule, A., Lemiale, V., Pesenti, A., Riviello, E. D., Mauri, T., Mancebo J., Brochard, L., & Burns, K. (2019). High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: A systematic review and meta-analysis. Intensive Care Medicine, 45(5), 563-572. Web.
Nishi, S. P. E., Zhang, W., Kuo, T. F., & Sharma, G. (2015). Oxygen therapy use in older adults with chronic obstructive pulmonary disease. PLoS One, 10(3), e0120684. Web.
Siemieniuk, R. A., Chu, D. K., Kim, L. H. Y., Güell-Rous, M. R., Alhazzani, W., & Soccal, P. M. (2018). Oxygen therapy for acutely ill medical patients: A clinical practice guideline. BMJ, 363. Web.