The Problem
The use of oxygen in prehospital care focuses on treating or preventing hypoxemia.
Excess oxygen (hyperoxia) delivery has critical effects on certain patients (Cornet, Kooter, Peters and Smulders, 2012). Hyperoxia can adversely affect patient outcomes. Oxygen delivery to patients without hypoxemia (low level of oxygen in the blood) can lead to adverse outcomes in the presence of hyperoxia. Oxygen is the most commonly delivered and administered to patients after medical and surgical procedures, but it is not necessarily the most commonly prescribed.
The research design and methods
The study is a comprehensive review of current organizational guidelines for oxygen delivery in pre-hospital care and the current evidence from human trials, which demonstrate the safety, efficacy, and complications of pre-hospital oxygen therapy.
The Results (Findings)
General Findings
- Prehospital care takes place in unique environments with logistical and educational challenges (Branson and Johannigman, 2013)
- Prehospital care requires oxygen therapy for patients with hypoxemia
- Oxygen should be titrated to achieve normoxemia
- It is important to review and change current practices of oxygen delivery in prehospital care
Specific Findings
Cardiovascular Disease
- There are risks of hypoxemia
- Further studies are necessary to determine the prehospital oxygen delivery for cardiopulmonary resuscitation, the oxygen level and its measurement
Respiratory Disease
- The presence of hypoxemia requires oxygen therapy
- Oxygen therapy should be specifically addressed to a given condition
Trauma
- Oxygen is necessary in cases of hypoxemia
- Oxygen titration to a normal level is required
- Hyperoxemia could present challenges because of unexpected outcomes among trauma patients with or without traumatic brain injuries
Other Conditions
- Pregnancies require titrated oxygen provided under certain pathophysiology conditions
- They also need analysis of oximetry or blood gas
Other conditions
- Breathlessness: oxygen therapy does not eliminate breathlessness in non-hypoxemic patients
- Sickle Cell Crisis: oxygen therapy is necessary in conditions of hypoxemia
- Carbon Monoxide Poisoning
Oxygen delivery is necessary in carbon monoxide poisoning
One hundred percent oxygen reduces the half-life of carboxyhemoglobin from 4 or 5 hours to 40 minutes
Perspectives of the conclusions
The study presents an overall account of the use of oxygen therapy in prehospital care in a short and concise manner. It shows that:
- Excess oxygen usages occur due to a common belief that it is non-toxic over short exposures
- There are logistic challenges in oxygen delivery
- Training challenges have resulted in excess oxygen usages in terms of dosages and indication of conditions
- Oxygen requires titration to lessen cases of hypoxemia and eliminate hyperoxemia except in conditions of carbon monoxide poisoning
- Overall, the conclusion captures the aim of the study clearly and precisely.
The article’s clinical relevance to the Respiratory Care profession
The article highlights the need to review current practices of oxygen delivery in prehospital care based on evidence presented. It shows that the prehospital care environment has logistical challenges. Nurses need continued training in prehospital care conditions. The article dispels the common myth that oxygen is non-toxic by showing that hyperoxia can negatively affect outcome. Best practice requires oxygen titration.
References
Branson, R. D., and Johannigman, J. A. (2013). Pre-Hospital Oxygen Therapy. Respiratory Care, 58(1), 86-97. .
Cornet, A. D., Kooter, A. J., Peters, M. J., and Smulders, Y. M. (2012). Supplemental oxygen therapy in medical emergencies: more harm than benefit? Arch Intern Med., 172(3), 289-290.