The main goal of medical oxygen is to provide adequate tissue perfusion and avoid tissue hypoxia, which can cause cellular damage and organ dysfunction. The secondary goal of medical oxygen is to reduce the work of breathing and cardiac output, which can improve respiratory and cardiovascular function. The tertiary goal of medical oxygen is to relieve symptoms such as dyspnea, chest pain, and confusion, which can improve the patient’s comfort and quality of life. In this article, we will discuss the role of medical oxygen in post-operative care as well as the benefits and risks.
The Role of Medical Oxygen in Post-Operative Care
Indications for Medical Oxygen
Medical oxygen is indicated for post-operative patients who have low blood oxygen levels (hypoxemia) due to various factors, such as incomplete lung re-expansion, reduced chest wall and diaphragmatic activity, hemodynamic impairment, residual effects of anaesthetic drugs, atelectasis, ventilation-perfusion mismatch, alveolar hypoventilation, and impaired upper airway patency. Medical oxygen can also be indicated for post-operative patients who have normal or high blood oxygen levels (normoxemia or hyperoxemia) but have conditions that may benefit from supplemental oxygen therapy, such as sepsis, shock, ischemia-reperfusion injury, or wound healing.
Contraindications for Medical Oxygen
Medical oxygen is contraindicated for post-operative patients who have conditions that may worsen with supplemental oxygen therapy, such as chronic obstructive pulmonary disease (COPD), carbon monoxide poisoning, methemoglobinemia, or paraquat poisoning. Medical oxygen can also be contraindicated for post-operative patients who have conditions that may not benefit from supplemental oxygen therapy, such as acute coronary syndrome, stroke, or traumatic brain injury.
Dose of Medical Oxygen
The dose of medical oxygen depends on several factors, such as the patient’s oxygen needs, clinical situation, availability of resources, comfort level, and potential complications. The dose of medical oxygen should be titrated to achieve a target blood oxygen level that is appropriate for each patient’s condition. The target blood oxygen level can vary from 75 to 100 mmHg (10.5 to 13.5 kPa) for PaO2 or from 88 to 100% for peripheral oxygen saturation (SpO2). The dose of medical oxygen should be monitored and adjusted frequently to avoid under-oxygenation or over-oxygenation.
Delivery Devices for Medical Oxygen
The delivery devices for medical oxygen can be classified into two types: low-flow devices and high-flow devices. Low-flow devices deliver a fixed flow rate of oxygen that does not meet the patient’s inspiratory demand, resulting in variable FiO2 depending on the patient’s breathing pattern and ambient air entrainment.
Benefits of Medical Oxygen
Another aspect of the role of medical oxygen in post-operative care is the benefits of its use. Medical oxygen has several benefits for post-operative patients who have low blood oxygen levels or conditions that may benefit from supplemental oxygen therapy.
Some of these benefits are:
- Improved tissue oxygenation and perfusion, which can prevent or reverse cellular damage and organ dysfunction.
- Reduced work of breathing and cardiac output, which can improve the respiratory and cardiovascular function.
- Relieved symptoms such as dyspnea, chest pain, and confusion, which can improve the patient’s comfort and quality of life.
- Reduced surgical site infection, which can improve the wound healing and prevent complications.
- Improved survival and recovery, which can reduce the mortality and morbidity.
Risks of Medical Oxygen
Medical oxygen has several risks for post-operative patients who have conditions that may worsen with supplemental oxygen therapy or who receive excessive or prolonged oxygen therapy:
- Oxygen toxicity, which can cause damage to the cells and tissues of the lungs, eyes, brain, or heart.
- Surgical site infection, which can impair the wound healing and increase complications.
- Hyperoxia-induced hypoxia, which can reduce the blood flow and oxygen delivery to the tissues.
- Carbon dioxide retention, which can cause respiratory acidosis and impaired consciousness.
- Fire hazard, which can cause burns and explosions.
Future Directions for Medical Oxygen
Medical oxygen is a common and essential treatment for post-operative patients, but it is not necessarily a benign therapy. There is still a lack of high-quality evidence and consensus on the optimal indications, goals, dose, delivery devices, benefits, and risks of medical oxygen for post-operative patients.
Therefore, more research is needed to determine the best practices and guidelines for medical oxygen in post-operative care:
- Developing new and improved delivery devices that can provide accurate and consistent FiO2, comfortable and secure fit, easy and safe application and removal, low noise and cost, and minimal complications.
- Conducting large-scale randomized controlled trials that can compare different oxygen regimens (liberal vs conservative vs targeted) for different patient groups (hypoxemic vs normoxemic vs hyperoxemic) and different outcomes (survival vs recovery vs quality of life).
- Implementing quality improvement initiatives that can monitor and audit the use of medical oxygen in post-operative care, such as pulse oximetry screening, oxygen prescription, oxygen titration, oxygen weaning, oxygen education, and oxygen feedback.
Conclusion
Medical oxygen can improve the oxygenation of tissues and organs, reduce the workload of the heart and lungs, and relieve symptoms such as dyspnea, chest pain, and confusion. However, medical oxygen also has some potential risks and complications, such as oxygen toxicity, surgical site infection, and hyperoxia-induced hypoxia.
Therefore, the role of medical oxygen in post-operative care should be carefully evaluated and By considering the indications, contraindications, goals, dose, delivery devices, benefits, risks, and future directions of medical oxygen in post-operative care, clinicians can provide optimal oxygen therapy for post-operative patients.
