Bench-to-bedside review: the effects of hyperoxia during critical illness.
Bench-to-bedside review: the effects of hyperoxia during critical illness.
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DOI：
10.1186/s13054-015-0996-4
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发表时间：
2015-08-17
期刊：
影响因子：
--
通讯作者：
van Westerloo DJ
中科院分区：
文献类型：
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作者：
Helmerhorst HJ;Schultz MJ;van der Voort PH;de Jonge E;van Westerloo DJ
氧气管理统一用于急诊和重症监护医学，在危急情况下具有挽救生命的潜力。然而，过度的氧合也具有有害的性质，在各种病理生理过程中，因此临床和转化研究调查高氧在危重病已获得越来越多的兴趣。活性氧是众所周知的高氧副产物，在细胞信号转导通路中起着关键作用。其影响是多样的，但当体内平衡被扰乱时，活性氧通常会维持组织损伤的恶性循环，其特征在于细胞损伤、细胞死亡和炎症。大量暴露的肺部最突出的症状包括气管支气管炎、肺水肿和呼吸衰竭。此外，吸收性肺不张是随着吸入氧气水平增加而产生的生理现象。高氧诱导的血管收缩在血管舒张性休克期间可能是有益的，但当器官灌注受损时，血液动力学变化也可能带来风险。在这种情况下，氧气可以被认为是一个多方面的代理商，一个可改变的风险因素，和一个可行的干预目标。尽管大多数临床结局仍在广泛研究中，但为了确保充分的组织氧合，同时防止高氧伤害，需要仔细滴定氧供应。
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.