Editorial Views  |   September 2016
Oxygen Therapy: When Is Too Much Too Much?
Author Notes
  • From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
  • Corresponding article on page 465.
    Corresponding article on page 465.×
  • Accepted for publication June 6, 2016.
    Accepted for publication June 6, 2016.×
  • Address correspondence to Dr. Subramaniam: bsubrama@bidmc.harvard.edu
Article Information
Editorial Views / Cardiovascular Anesthesia / Renal and Urinary Systems / Electrolyte Balance / Respiratory System / Quality Improvement
Editorial Views   |   September 2016
Oxygen Therapy: When Is Too Much Too Much?
Anesthesiology 9 2016, Vol.125, 449-450. doi:10.1097/ALN.0000000000001227
Anesthesiology 9 2016, Vol.125, 449-450. doi:10.1097/ALN.0000000000001227
THERE are approximately 300,000 cardiac surgical procedures annually utilizing cardiopulmonary bypass (CPB) in the United States.1  The delivery of oxygen has been a cornerstone of anesthesia practice, with titration of oxygen therapy to ensure avoidance of potentially injurious periods of hypoxemia. However, the same attention has not been afforded for levels of relative hyperoxemia, mostly due to the assumption that excess oxygen is relatively harmless. Emerging clinical data within a variety of arenas suggest that this assumption may not be true. There appears to be potentially deleterious effects from hyperoxemia, whether it be demonstration of extension of infarct size postmyocardial infarction2  or worse neurologic outcomes and higher mortality in patients receiving therapeutic hypothermia following return of spontaneous circulation after cardiac arrest.3  Given these data, there has been rekindled interest in the conceivably detrimental consequences of hyperoxemia in the domain of CPB during cardiac surgery where ischemia–reperfusion injury may lead to an increased susceptibility to formation of reactive oxygen species. In this issue of Anesthesiology, McGuinness et al.4  investigate the avoidance of hyperoxemia during CPB on postoperative acute kidney injury in cardiac surgery.
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