Oxygen has an ubiquitous place in any critical care unit. If some body is labeled as critically ill , it becomes mandatory for a tube to be inserted per nasal. It is more of a conditioned reflex and sort of a socio- medical necessity .The futility of oxygen administration in critically ill is most evident in the management of STEMI.
Inconvenient questions
- Does the oxygen we supply , ever reach the disputed site myocardium (From the port of entry . . . namely the nose )
- Does it improve the myocardial salvage ?
There is generally no hypoxia associated with STEMI . Even if it is there , the ischemic myocyte can not be oxygenated by increasing the systemic saturation as the problem is with the delivery of oxygen due to defective supply.
What does the guidelines say regarding o2 ?
Read yourself http://circ.ahajournals.org/cgi/content/full/110/5/588
Final message
Routine oxygen administration is required to create the intensive care ambiance .
Oxygen administration by default has no scientific role.
However, it is generally not harmful . As long a drug is not harming the patients , inappropriate therapy is forgiven by modern medicine.
When is oxygen really indicated in STEMI ?
- Significant persistent Hypoxia
- Associated LVF
- Any arrhythmia
- COPD
Forbidden discussions in academic forums
Oxygen administration has become mandatory to generate revenue for the cash starved corporates .It is a standard practice to charge these patients on hourly basis of o2 usage in many hospitals.
Dr.S.Venkatesan MD 