Download PDF
Anästhesiol Intensivmed Notfallmed Schmerzther 2005; 40(10): 604-608
DOI: 10.1055/s-2005-870468
Mini-Symposium
© Georg Thieme Verlag KG Stuttgart · New York

Hohe FIO2 beim Intensivpatienten: Pro und Kontra

High FIO2 During Mechanical Ventilation: Pro - ConH.  U.  Rothen1
  • 1 Klinik für Intensivmedizin, Inselspital, Bern, Schweiz
Further Information

Publication History

Publication Date:
27 October 2005 (online)

Also available at
   Permissions and Reprints

Einleitung

Ziel der zusätzlichen Gabe von Sauerstoff und der mechanischen Beatmung ist in der Regel die Sicherstellung und Optimierung der alveolären Ventilation und des pulmonalen Gasaustausches. Diese Maßnahmen sind keine Therapien im engeren Sinne, sie haben lediglich den Zweck, eine vorübergehende Störung der Atmung zu überbrücken bis zur Besserung oder Heilung der zugrunde liegenden Erkrankung. Dabei gilt es zu beachten, dass die mechanische Beatmung selbst, wie nachfolgend kurz dargelegt, zu einer Störung des Gasaustausches führen kann. Mit der Absicht, den gestörten Gasaustausch zu korrigieren wird - oft sogar beim Patienten mit gesunden Lungen - der Anteil an Sauerstoff im inspiratorischen Gasgemisch (FIO2) über den normalen Wert von 0,21 erhöht. Wie weiter unten diskutiert gibt es Hinweise, dass eine Anhebung des Partialdruckes von Sauerstoff im arteriellen Blut über die normalen Werte (erreicht durch eine Erhöhung von FIO2) in gewissen Situationen günstig sein kann. Es gilt dabei aber zu beachten, dass solche Maßnahmen auch potenzielle Nebenwirkungen haben können. Ziel dieser kurzen Übersicht ist es, die Veränderung des Gasaustausches bei mechanischer Beatmung, einen möglichen Nutzen und potenzielle Risiken der Anwendung von hoher FIO2 darzustellen.

Literatur

  • 1 Hedenstierna G, Rothen H U. Atelectasis formation during anesthesia: causes and measures to prevent it.  J Clin Monit Comput. 2000;  16 329-335
    CrossrefPubMedSearch in Google Scholar
  • 2 Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L. Pulmonary densities during anesthesia with muscular relaxation - a proposal of atelectasis.  Anesthesiology. 1985;  62 422-428
    PubMedSearch in Google Scholar
  • 3 Lundquist H, Hedenstierna G, Strandberg Å, Tokics L, Brismar B. CT-assessment of dependent lung densities in man during general anaesthesia.  Acta Radiol. 1995;  36 626-632
    CrossrefPubMedSearch in Google Scholar
  • 4 von Euler U S, Liljestrand G. Observations on the pulmonary arterial blood pressure in the cat.  Acta Physiol Scand. 1947;  12 301-320
    PubMedSearch in Google Scholar
  • 5 Rahn H, Farhi L E. Gaseous environment and atelectasis.  Fed Proc. 1963;  22 1035-1041
    PubMedSearch in Google Scholar
  • 6 Alexander J I, Spence A A, Parikh R K, Stuart B. The role of airway closure in postoperative hypoxemia.  Br J Anaesth. 1973;  45 34-40
    PubMedSearch in Google Scholar
  • 7 Rothen H U, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Airway closure, atelectasis and gas exchange during general anaesthesia.  Br J Anaesth. 1998;  81 681-686
    CrossrefPubMedSearch in Google Scholar
  • 8 Rothen H U, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia - a computed tomography study.  Br J Anaesth. 1993;  71 788-795
    PubMedSearch in Google Scholar
  • 9 Oczenski W, Schwarz S, Fitzgerald R D. Vital capacity manoeuvre in general anaesthesia: useful or useless?.  Eur J Anaesthesiol. 2004;  21 253-259
    CrossrefPubMedSearch in Google Scholar
  • 10 Oczenski W, Schwarz S, Fitzgerald R D. Clinical impact of recruitment maneuvers in patients with acute respiratory distress syndrome.  Anasthesiol Intensivmed Notfallmed Schmerzther. 2004;  39 463-470
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Hebert P C, Wells G, Blajchman M A, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group.  N Engl J Med. 1999;  340 409-417
    CrossrefPubMedSearch in Google Scholar
  • 12 Kabon B, Fleischmann E, Treschan T, Taguchi A, Kapral S, Kurz A. Thoracic epidural anesthesia increases tissue oxygenation during major abdominal surgery.  Anesth Analg. 2003;  97 1812-1817
    PubMedSearch in Google Scholar
  • 13 Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001;  345 1368-1377
    CrossrefPubMedSearch in Google Scholar
  • 14 Dellinger R P, Carlet J M, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall J C, Parker M M, Ramsay G, Zimmerman J L, Vincent J L, Levy M M. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock.  Crit Care Med. 2004;  32 858-873
    CrossrefPubMedSearch in Google Scholar
  • 15 Rao S V, Jollis J G, Harrington R A, Granger C B, Newby L K, Armstrong P W, Moliterno D J, Lindblad L, Pieper K, Topol E J, Stamler J S, Califf R M. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes.  JAMA. 2004;  292 1555-1562
    CrossrefPubMedSearch in Google Scholar
  • 16 Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, Fumagalli R. A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group.  N Engl J Med. 1995;  333 1025-1032
    CrossrefPubMedSearch in Google Scholar
  • 17 Greif R, Akca O, Horn E P, Kurz A, Sessler D I. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group.  N Engl J Med. 2000;  342 161-167
    CrossrefPubMedSearch in Google Scholar
  • 18 Pryor K O, Fahey T J 3rd , Lien C A, Goldstein P A. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population. A randomized controlled trial.  JAMA. 2004;  291 79-87
    CrossrefPubMedSearch in Google Scholar
  • 19 Hopf H W, Hunt T K, Rosen N. Supplemental oxygen and risk of surgical site infection.  JAMA. 2004;  291 1958-1959
    PubMedSearch in Google Scholar
  • 20 Kabon B, Nagele A, Reddy D, Eagon C, Fleshman J W, Sessler D I, Kurz A. Obesity decreases perioperative tissue oxygenation.  Anesthesiology. 2004;  100 274-280
    CrossrefPubMedSearch in Google Scholar
  • 21 Goll V, Akca O, Greif R, Freitag H, Arkilic C F, Scheck T, Zoeggeler A, Kurz A, Krieger G, Lenhardt R, Sessler D I. Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting.  Anesth Analg. 2001;  92 112-117
    PubMedSearch in Google Scholar
  • 22 Joris J L, Poth N J, Djamadar A M, Sessler D I, Hamoir E E, Defechereux T R, Meurisse M R, Lamy M L. Supplemental oxygen does not reduce postoperative nausea and vomiting after thyroidectomy.  Br J Anaesth. 2003;  91 857-861
    CrossrefPubMedSearch in Google Scholar
  • 23 Purhonen S, Turunen M, Ruohoaho U M, Niskanen M, Hynynen M. Supplemental oxygen does not reduce the incidence of postoperative nausea and vomiting after ambulatory gynecologic laparoscopy.  Anesth Analg. 2003;  96 91-96
    PubMedSearch in Google Scholar
  • 24 Rosenberg-Adamsen S, Lie C, Bernhard A, Kehlet H, Rosenberg J. Effect of oxygen treatment on heart rate after abdominal surgery.  Anesthesiology. 1999;  90 380-384
    PubMedSearch in Google Scholar
  • 25 Kotani N, Hashimoto H, Sessler D I, Muraoka M, Hashiba E, Kubota T, Matsuki A. Supplemental intraoperative oxygen augments antimicrobial and proinflammatory responses of alveolar macrophages.  Anesthesiology. 2000;  93 15-25
    PubMedSearch in Google Scholar
  • 26 Meier J, Kemming G I, Kisch-Wedel H, Wolkhammer S, Habler O P. Hyperoxic ventilation reduces 6-hour mortality at the critical hemoglobin concentration.  Anesthesiology. 2004;  100 70-76
    PubMedSearch in Google Scholar
  • 27 Meier J, Kemming G I, Kisch-Wedel H, Blum J, Pape A, Habler O P. Hyperoxic ventilation reduces six-hour mortality after partial fluid resuscitation from hemorrhagic shock.  Shock. 2004;  22 240-247
    PubMedSearch in Google Scholar
  • 28 Reinert M, Barth A, Rothen H U, Schaller B, Takala J, Seiler R W. Effects of cerebral perfusion pressure and increased fraction of inspired oxygen on brain tissue oxygen, lactate and glucose in patients with severe head injury.  Acta Neurochir. 2003;  145 341-349
    PubMedSearch in Google Scholar
  • 29 Dantzker D R, Wagner P D, West J B. Instability of lung units with low VA/Q ratios during O2 breathing.  J Appl Physiol. 1975;  38 886-895
    PubMedSearch in Google Scholar
  • 30 Wollmer P, Schairer W, Bos J A, Bakker W, Krenning E P, Lachmann B. Pulmonary clearance of 99mTc-DTPA during halothane anaesthesia.  Acta Anaesthesiol Scand. 1990;  34 572-575
    PubMedSearch in Google Scholar
  • 31 Wagner P D, Laravuso R B, Uhl R R, West J B. Continuous distribution of ventilation-perfusion ratios in normal subjects breathing air and 100 % O2.  J Clin Invest. 1974;  54 54-68
    CrossrefPubMedSearch in Google Scholar
  • 32 Benoit Z, Wicky S, Fischer J F, Frascarolo P, Chapuis C, Spahn D R, Magnusson L. The effect of increased FIO2 before tracheal extubation on postoperative atelectasis.  Anesth Analg. 2002;  95 1777-1781
    PubMedSearch in Google Scholar
  • 33 Loeckinger A, Kleinsasser A, Keller C, Schaefer A, Kolbitsch C, Lindner K H, Benzer A. Administration of oxygen before tracheal extubation worsens gas exchange after general anesthesia in a pig model.  Anesth Analg. 2002;  95 1772-1776
    PubMedSearch in Google Scholar
  • 34 Edmark L, Kostova-Aherdan K, Enlund M, Hedenstierna G. Optimal oxygen concentration during induction of general anesthesia.  Anesthesiology. 2003;  98 28-33
    CrossrefPubMedSearch in Google Scholar
  • 35 Coussa M, Proietti S, Schnyder P, Frascarolo P, Suter M, Spahn D R, Magnusson L. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients.  Anesth Analg. 2004;  98 1491-1495
    PubMedSearch in Google Scholar
  • 36 Plotz F B, Slutsky A S, van Vught A J, Heijnen C J. Ventilator-induced lung injury and multiple system organ failure: a critical review of facts and hypotheses.  Intensive Care Med. 2004;  30 1865-1872
    CrossrefPubMedSearch in Google Scholar
  • 37 Clark J M, Lambertsen C J. Pulmonary oxygen toxicity: a review.  Pharmacol Rev. 1971;  23 137-133
    PubMedSearch in Google Scholar
  • 38 Sackner M A, Landa J, Hirsch J, Zapata A. Pulmonary effects of oxygen breathing. A 6-hour study in normal men.  Ann Intern Med. 1975;  82 40-43
    PubMedSearch in Google Scholar
  • 39 Comroe J H, Dripps R D, Dumke P R, Deming M. The effect of inhalation of high concentrations of oxygen for 24 hours on normal men at sea level and at simulated altitude of 18'000.  JAMA. 1945;  128 710ff
    PubMedSearch in Google Scholar
  • 40 Singer M M, Wright F, Stanley L K, Roe B B, Hamilton W K. Oxygen toxicity in man. A prospective study in patients after open-heart surgery.  N Engl J Med. 1970;  283 1473-1478
    PubMedSearch in Google Scholar
  • 41 Winter P M, Smith G. The toxicity of oxygen.  Anesthesiology. 1972;  37 210-241
    PubMedSearch in Google Scholar
  • 42 Flynn J T, Bancalari E, Snyder E S, Goldberg R N, Feuer W, Cassady J, Schiffman J, Feldman H I, Bachynski B, Buckley E. A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity.  N Engl J Med. 1992;  326 1050-1054
    PubMedSearch in Google Scholar
  • 43 Haltern C, Siekmann U P, Rump A F, Rossaint R. Hyperbaric oxygen therapy (HBO): current standing.  Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;  35 487-502
    Thieme ConnectPubMedSearch in Google Scholar
  • 44 Pagano A, Barazzone-Argiroffo C. Alveolar cell death in hyperoxia-induced lung injury.  Ann N Y Acad Sci. 2003;  1010 405-416
    CrossrefPubMedSearch in Google Scholar
  • 45 Lum H, Roebuck K A. Oxidant stress and endothelial cell dysfunction.  Am J Physiol Cell Physiol. 2001;  280 719-741
    PubMedSearch in Google Scholar
  • 46 Kotani N, Hashimoto H, Sessler D I, Muraoka M, Hashiba E, Kubota T, Matsuki A. Supplemental intraoperative oxygen augments antimicrobial and proinflammatory responses of alveolar macrophages.  Anesthesiology. 2000;  93 15-25
    PubMedSearch in Google Scholar
  • 47 Schreck R, Rieber P, Baeuerle P A. Reactive oxygen intermediates as apparently widely used messengers in the activation of the NF-kappa B transcription factor and HIV-1.  EMBO J. 1991;  10 2247-2258
    PubMedSearch in Google Scholar
  • 48 Shea L M, Beehler C, Schwartz M, Shenkar R, Tuder R, Abraham E. Hyperoxia activates NF-kappa B and increases TNF-alpha and IFN-gamma gene expression in mouse pulmonary lymphocytes.  J Immunol. 1996;  157 3902-3908
    PubMedSearch in Google Scholar
  • 49 Waxman A B, Einarsson O, Seres T, Knickelbein R G, Warshaw J B, Johnston R, Homer R J, Elias J A. Targeted lung expression of interleukin-11 enhances murine tolerance of 100 % oxygen and diminishes hyperoxia-induced DNA fragmentation.  J Clin Invest. 1998;  101 1970-1982
    PubMedSearch in Google Scholar
  • 50 Mantell L L, Lee P J. Signal transduction pathways in hyperoxia-induced lung cell death.  Mol Genet Metab. 2000;  71 359-370
    CrossrefPubMedSearch in Google Scholar
  • 51 Barazzone C, White C W. Mechanisms of cell injury and death in hyperoxia: role of cytokines and Bcl-2 family proteins.  Am J Respir Cell Mol Biol. 2000;  22 517-519
    PubMedSearch in Google Scholar
  • 52 Chow C W, Herrera Abreu M T, Suzuki T, Downey G P. Oxidative stress and acute lung injury.  Am J Respir Cell Mol Biol. 2003;  29 427-431
    CrossrefPubMedSearch in Google Scholar
  • 53 Knight P R, Kurek C, Davidson B A, Nader N D, Patel A, Sokolowski J, Notter R H, Holm B A. Acid aspiration increases sensitivity to increased ambient oxygen concentrations.  Am J Physiol Lung Cell Mol Physiol. 2000;  278 1240-1247
    PubMedSearch in Google Scholar
  • 54 Chabot F, Mitchell J A, Gutteridge J M, Evans T W. Reactive oxygen species in acute lung injury.  Eur Respir J. 1998;  11 745-757
    PubMedSearch in Google Scholar
  • 55 Bhatia M, Moochhala S. Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome.  J Pathol. 2004;  202 145-156
    CrossrefPubMedSearch in Google Scholar
  • 56 Tateda K, Deng J C, Moore T A, Newstead M W, Paine 3rd  R, Kobayashi N, Yamaguchi K, Standiford T J. Hyperoxia mediates acute lung injury and increased lethality in murine Legionella pneumonia: the role of apoptosis.  J Immunol. 2003;  170 4209-4216
    PubMedSearch in Google Scholar
  • 57 Berend N. Protective effect of hypoxia on bleomycin lung toxicity in the rat.  Am Rev Respir Dis. 1984;  130 307-308
    PubMedSearch in Google Scholar
  • 58 Lachmann B. Open up the lung and keep the lung open.  Intensive Care Med. 1992;  18 319-321
    CrossrefPubMedSearch in Google Scholar
  • 59 Comhair S A, Erzurum S C. Antioxidant responses to oxidant-mediated lung diseases.  Am J Physiol Lung Cell Mol Physiol. 2002;  283 246-255
    PubMedSearch in Google Scholar
  • 60 Fu E S, Downs J B, Schweiger J W, Miguel R V, Smith R A. Supplemental oxygen impairs detection of hypoventilation by pulse oximetry.  Chest. 2004;  126 1552-1558
    CrossrefPubMedSearch in Google Scholar

PD Dr. Hans Ulrich Rothen

Leitender Arzt, Klinik für Intensivmedizin

Inselspital · CH-3010 Bern · Schweiz ·

Email: hrothen@insel.ch