O2 bad if pt already 100% RA?

[Emergent]

I recently heard that O2 is contraindicated if pt already has great sats. In the ER, though, part of some of our protocols is O2 on all. Any hard facts with rationale? I would love to learn best practice for this situation

[TU RN, DNP, CRNA]

There are lies, there are damned lies, then there are statistics. Maybe he was using those articles to push an opinion or agenda (even though this makes no sense since he stands to gain nothing by succeeding) - it wouldn't be the first time somebody tried using statistics to prove a point. 90% of the time people use statistics in conversation they're trying to prove a point

My ACLS class recently cited research stating hyperoxygenation during resuscitation leads to poorer outcomes. I don't have the articles for you to critique, but if my own ventures into critiquing research articles have taught me anything it's that just about any scholarly article has something wrong with it or something that can be improved.

[TraumaSurfer]

There are lies, there are damned lies, then there are statistics. Maybe he was using those articles to push an opinion or agenda (even though this makes no sense since he stands to gain nothing by succeeding) - it wouldn't be the first time somebody tried using statistics to prove a point. 90% of the time people use statistics in conversation they're trying to prove a point

My ACLS class recently cited research stating hyperoxygenation during resuscitation leads to poorer outcomes. I don't have the articles for you to critique, but if my own ventures into critiquing research articles have taught me anything it's that just about any scholarly article has something wrong with it or something that can be improved.

There is not much argument about hyperoxygenation or hyperoxia. The problem is in assuming an SpO2 of 100% means the patient has a PaO2 high enough for the definition of hyperoxia. For post resuscitaion, the oxygen should be weaned once the patient is stabilized and ABGs are done.

If you have ever had the O2 to a BVM become diconnected or hooked up to the air flowmeter by mistake during a code or crashing patient, you will quickly learn how difficult it is to resuscitate an adult with just 21%. Unfortunately in the adult world (ED or back of ambulance) you do not always have access to a blender while bagging.

As with any drug, oxygen should not be given unless it is specifically indicated.

Even outside of concern about CO2 retainers, oxygen can be harmful. Keep in mind that the classic radical presented in organic chemistry is the oxygen free radical... a very energetic atom which can cause significant damage to tissues.

Except in cases of hypoxia, supplemental oxygen yields no benefit. Hence the current ACLS guidelines to administer 100% oxygen only to patients in arrest but to titrate to >93% for everybody else.

That said, keep in mind that SpO2 is a lagging indicator of respiratory compromise. A more useful indicator is end-tidal CO2.