Oxygen therapy in the intensive care unit

Wang, Ping1,#; Huang, Qixin1,#; Liu, Bin1; Xu, Qiangjun1; Li, Xingsong2; Feng, Guidong2; Liu, Yiming3,*

Author Information

1Department of Emergency, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China

2Department of Emergency, The Second People’s Hospital of Qingyuan City, Qingyuan, Guangdong Province, China

3Department of Emergency and Disaster Medicine, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong Province, China

*Correspondence to: Yiming Liu, MS, liuyiming@sysush.com.

#Both authors contributed equally to this work.

Funding:This work was supported by the Natural Science Foundation of Guangdong Province, No. 2023A1515010383 (to BL).

Abstract

Oxygen therapy is a crucial treatment method for maintaining vital signs in patients in the intensive care unit. However, several controversial issues have emerged regarding its clinical application. This article analyzes current research trends in oxygen therapy in the intensive care unit and provides guidance and recommendations. Relevant literature was retrieved from the Web of Science Core Collection, and keyword co-occurrence and highly cited literature hotspot analyses were conducted using VOSviewer 1.6.19 software. The key topics related to oxygen therapy in the intensive care unit primarily focus on four areas: oxygen therapy and mechanical ventilation in the intensive care unit, extracorporeal membrane oxygenation therapy for coronavirus disease 2019 and its role in reducing mortality, research on hypoxia and oxygen saturation monitoring, and oxygen inhalation therapy in the intensive care unit. The analysis of highly cited literature indicates that the main research hotspots regarding oxygen therapy used in the intensive care unit focus primarily on conservative oxygen therapy, high-flow nasal oxygen therapy, comparisons of high- and low-oxygenation strategies, and research on hyperbaric oxygen therapy. First, the potential of conservative oxygen therapy to reduce mortality rates in the intensive care unit has attracted considerable attention; however, further clinical studies are needed to validate its optimal parameters and suitable patient populations. Second, high-flow nasal oxygen therapy has been shown to be effective in alleviating respiratory distress and reducing the need for intubation. This therapy can deliver oxygen flows of up to 60 L/min, effectively improving respiratory distress and decreasing intubation demands. In patients subjected to high-risk extubation, the combination of high-flow nasal oxygen therapy and noninvasive ventilation significantly lowers the rate of reintubation, making the combined approach one of the best strategies to prevent respiratory failure after extubation in the intensive care unit. Third, there are differences between lower and higher oxygenation strategies regarding their effects on patient mortality, long-term outcomes, and clinician preferences; however, there is currently no clear evidence indicating which strategy is superior. Clinicians’ preferences regarding various oxygenation targets may impact the design of future studies. Finally, hyperbaric oxygen therapy is recognized as an effective supportive treatment for various critical conditions and has significant application value in acute severe traumatic brain injury, cerebral resuscitation, and cardiopulmonary resuscitation. Currently, researchers are continually exploring the latest oxygen therapies in the intensive care unit. Several randomized controlled clinical trials investigating automated oxygen control, novel high-flow nasal oxygen therapy, and combined oxygen therapy are underway. The results of these trials should be closely observed. Overall, this article provides a systematic review and valuable reference for the scientific and rational application of oxygen therapy in the intensive care unit. Future research should focus on verifying the optimal parameters of conservative oxygen therapy, assessing oxygen needs in different patient populations, evaluating the long-term effects of oxygen treatment, and developing novel oxygen therapy technologies and devices.

摘要

氧疗是重症监护室（ICU）中用以维持患者生命体征的重要治疗手段。然而，其临床应用中出现了一些争议性问题。本文分析重症监护室氧疗的研究现状，并提供指导与建议。通过Web of Science核心合集检索相关文献，运用VOSviewer 1.6.19软件进行关键词共现和高被引文献热点分析。重症监护室氧疗相关核心主题主要集中在四个领域：重症监护室中的氧疗与机械通气；2019冠状病毒病的体外膜肺氧合治疗及其在降低死亡率中的作用；缺氧及氧饱和度监测的研究；以及重症监护室中的吸氧治疗。高被引文献分析表明，重症监护室氧疗的主要研究热点集中在保守氧疗、经鼻高流量氧疗、高氧合与低氧合策略的比较以及高压氧治疗研究等方面。首先，保守氧疗在降低重症监护室患者死亡率方面的潜力备受关注，但其最佳参数和适用人群仍需进一步的临床研究验证。其次，经鼻高流量氧疗已被证明能有效缓解呼吸窘迫并减少插管需求，该疗法可提供高达60升/分钟的氧流量，有效改善呼吸窘迫并降低插管需求。在存在高危拔管风险的患者中，经鼻高流量氧疗联合无创通气可显著降低再插管率，使联合疗法成为预防重症监护室拔管后呼吸衰竭的最佳策略之一。第三，较低与较高氧合策略在患者死亡率、远期结局以及临床医生偏好方面的影响存在差异，但目前尚无明确证据表明哪种策略更优。临床医生对不同氧合目标的偏好可能影响未来研究的设计。最后，高压氧治疗被认为是多种危重病症的有效支持治疗手段，在急性重症创伤性脑损伤、脑复苏及心肺复苏中具有重要应用价值。目前，研究者们正不断探索重症监护室的最新氧疗技术，多项关于自动氧控制、新型经鼻高流量氧疗以及联合氧疗的随机对照临床试验正在进行中，其结果值得密切关注。总之，本文为氧疗在重症监护室的科学、合理应用提供了系统性回顾和有价值的参考。未来的研究应侧重于验证保守氧疗的最佳参数、评估不同患者群体的氧需求、评价氧疗的远期效应以及开发新型氧疗技术与设备。