Melclin
Forum Deputy Chief
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Actually we had a meeting with our new medical director that just took over about a month ago about this recently, he showed up pictures of coronary arteries of an otherwise healthy person on room air and on high concentrations of O2. The people with O2 had much more limited blood flow to the heart, it was actually scary what the difference was. The people with high flow O2 looked like they had a partial occlusion of the vessels. Also instructed us to not place patients on O2 unless they have a SaO2 of 90% or less, and that our target should be 94%.
That may be so, and it is roughly consistent with my understand as well, but it doesn't, in itself, really constitute compelling evidence against O2. The peak body recommendations are what they are and I'm sure the British thoracic society considered those 'pictures' along with many others when they suggested empirical high concentration O2 in 'critical illness'. It has to be said, arrythmias are not usually listed in that category but the evidence doesn't really strongly point one way or the other as far as I'm aware. If you were to place this pt on O2 for 5-10 mins while you sorted everything else out, paying particular attention to the presence of critical illness that may require O2 and especially the reliability of the oximetry, then you titrated the O2 to a more reasonable level, you would probably not be sent to hell for being a terrible clinician is all I'm saying.