Oxygen toxicity: Difference between revisions
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==Background== | ==Background== | ||
* | *The harmful effects of breathing oxygen at higher partial pressures than normal | ||
**Partial pressure of O2 at sea level = 0.21 ATM | |||
*Toxicity based on both time of exposure and partial pressure of oxygen | |||
**Generally, FiO2 of 40% or less (0.40 ATM) can be tolerated indefinitely<ref name="Hedley">Hedley-Whyte J. Pulmonary Oxygen Toxicity: Investigation and Mentoring. The Ulster Medical Journal. 2008;77(1):39-42.</ref> | |||
**Most common in hyperbaric oxygen therapy, scuba divers and prolonged administration of normobaric supplemental oxygen | |||
**Pulmonary toxicity occurs sooner and at lower partial pressures than CNS toxicity<ref name="Hedley" />, however there is no predictable pattern or sequence of symptoms for CNS toxicity (initial symptom may be seizure/coma)<ref name="Bitterman" /> | |||
{{Diving Physiology}} | |||
==Clinical Features== | ==Clinical Features== | ||
===Pulmonary=== | ===Pulmonary=== | ||
*Tracheobronchial irritation → pleuritic chest pain, dyspnea and | *Tracheobronchial irritation (initial manifestation) → pleuritic [[chest pain]], [[dyspnea]] and [[cough]]ing<ref name="Thomson">Thomson L, Paton J. Oxygen toxicity. Paediatr Respir Rev. 2014 Jun;15(2):120-3.</ref><ref name="Bitterman">Bitterman H. Bench-to-bedside review: Oxygen as a drug. Critical Care. 2009;13(1):205. doi:10.1186/cc7151.</ref> | ||
*Atelectasis | *Atelectasis | ||
*Diffuse alveolar damage → [[Pulmonary edema]]/[[ARDS]] | *Diffuse alveolar damage → [[Pulmonary edema]]/[[ARDS]] | ||
===Central nervous system=== | ===Central nervous system=== | ||
*Tunnel vision | *[[visual disturbances|Tunnel vision]] | ||
*Tinnitus | *[[Tinnitus]] | ||
*[[Nausea]] | *[[Nausea]] | ||
*Facial twitching | *Facial twitching | ||
*Irritability (personality changes, anxiety, confusion, etc.) | *Irritability (personality changes, anxiety, [[confusion]], etc.) | ||
*[[Seizure]] | *[[Seizure]] | ||
===Ocular=== | ===Ocular=== | ||
*Retinopathy of prematurity ( | *Retinopathy of prematurity (retrolental fibroplasia) - seen in premature infants | ||
*Hyperoxic myopia - seen in adults exposed to repeated toxic levels of oxygen<ref>Anderson B, Farmer JC. Hyperoxic myopia. Transactions of the American Ophthalmological Society. 1978;76:116-124.</ref> | |||
* | |||
**Resolves spontaneously over several weeks | **Resolves spontaneously over several weeks | ||
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{{Scuba diving DDX}} | {{Scuba diving DDX}} | ||
== | ==Evaluation== | ||
* | *Generally clinical | ||
==Management== | ==Management== | ||
* | *Lower inhaled partial pressure of oxygen to as low as tolerated while maintaining tissue perfusion<ref name="Deutschman">Deutschman, C. S., & Neligan, P. J. (2010). Evidence-based practice of critical care. Philadelphia, PA: Saunders/Elsevier.</ref> | ||
==Disposition== | ==Disposition== | ||
| Line 38: | Line 44: | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Environmental]] | ||
Latest revision as of 13:15, 18 July 2020
Background
- The harmful effects of breathing oxygen at higher partial pressures than normal
- Partial pressure of O2 at sea level = 0.21 ATM
- Toxicity based on both time of exposure and partial pressure of oxygen
- Generally, FiO2 of 40% or less (0.40 ATM) can be tolerated indefinitely[1]
- Most common in hyperbaric oxygen therapy, scuba divers and prolonged administration of normobaric supplemental oxygen
- Pulmonary toxicity occurs sooner and at lower partial pressures than CNS toxicity[1], however there is no predictable pattern or sequence of symptoms for CNS toxicity (initial symptom may be seizure/coma)[2]
Diving Physiology
- Pascals Law applies to the diving body (without air filled areas such as lungs) states that the pressure applied to any part of the enclosed liquid will be transmitted equally in all directions through the liquid.
- Boyles Law applies to the diving body's air filled areas such as lungs, sinuses, middle ear, and states that the volume and pressure of a gas at a given temperature are inversely related.
- At 2 ATA (10m/33ft) a given gas would be 1/2 it's volume, at 3 ATA (20m/66ft) it would be 1/3 it's volume and so on.
Clinical Features
Pulmonary
- Tracheobronchial irritation (initial manifestation) → pleuritic chest pain, dyspnea and coughing[3][2]
- Atelectasis
- Diffuse alveolar damage → Pulmonary edema/ARDS
Central nervous system
- Tunnel vision
- Tinnitus
- Nausea
- Facial twitching
- Irritability (personality changes, anxiety, confusion, etc.)
- Seizure
Ocular
- Retinopathy of prematurity (retrolental fibroplasia) - seen in premature infants
- Hyperoxic myopia - seen in adults exposed to repeated toxic levels of oxygen[4]
- Resolves spontaneously over several weeks
Differential Diagnosis
Diving Emergencies
- Barotrauma of descent
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
- Barotrauma of ascent
- Pulmonary barotrauma (pulmonary overpressurization syndrome)
- Decompression sickness (DCS)
- Arterial gas embolism
- Alternobaric vertigo
- Facial baroparesis (Bells Palsy)
- At depth injuries
- Oxygen toxicity
- Nitrogen narcosis
- Hypothermia
- Contaminated gas mixture (e.g. CO toxicity)
- Caustic cocktail from rebreathing circuit
Evaluation
- Generally clinical
Management
- Lower inhaled partial pressure of oxygen to as low as tolerated while maintaining tissue perfusion[5]
Disposition
- Admit
See Also
External Links
References
- ↑ 1.0 1.1 Hedley-Whyte J. Pulmonary Oxygen Toxicity: Investigation and Mentoring. The Ulster Medical Journal. 2008;77(1):39-42.
- ↑ 2.0 2.1 Bitterman H. Bench-to-bedside review: Oxygen as a drug. Critical Care. 2009;13(1):205. doi:10.1186/cc7151.
- ↑ Thomson L, Paton J. Oxygen toxicity. Paediatr Respir Rev. 2014 Jun;15(2):120-3.
- ↑ Anderson B, Farmer JC. Hyperoxic myopia. Transactions of the American Ophthalmological Society. 1978;76:116-124.
- ↑ Deutschman, C. S., & Neligan, P. J. (2010). Evidence-based practice of critical care. Philadelphia, PA: Saunders/Elsevier.