Tag Archive for: Oxygen

The Death of MONA in ACS: Part II – Oxygen

05 Nov
November 5, 2017

Background: The first report for supplemental oxygen for angina was in 1900, and since then oxygen therapy has been a commonly used treatment of patients with ST-Elevation Myocardial Infarction (STEMI).  The reason for this is the belief that supplemental oxygen will increase oxygen delivery to ischemic myocardium and help reduce myocardial injury.  This belief is based off lab studies and older clinical trials, but there have been other studies that suggest potential adverse physiologic effects of supplemental oxygen in acute coronary syndromes (ACS) (i.e reduced coronary blood flow, increased coronary vascular resistance, and production of reactive oxygen species) causing vasoconstriction and reperfusion injury. Read more →

The DETO2X Trial: Do Patients with AMI Need Supplemental O2?

21 Sep
September 21, 2017

Background: Each year approximately 790,000 Americans suffer an acute myocardial infarction (AMI) (Benjamin 2017). Traditional treatment for an acute myocardial infarction has included morphine, oxygen, nitroglycerine and aspirin (MONA) with interventions such as percutaneous coronary intervention providing more definitive management. There has been little data from randomized control studies that supports the use of oxygen in AMI. Recent studies such as the AVOID trial suggest that hyperoxia results in harm while a 2016 Cochrane Review suggest no benefit in supplemental oxygen. (Stub 2015, Cabello 2016). There has, however, not been a large randomized control study comparing supplemental O2 to ambient air with patient centered outcomes until the DETO2X-AMI trial. Read more →

February 2017 REBEL Cast: The All Hyperoxia Edition

20 Feb
February 20, 2017

Background: Many providers and health care workers place oxygen on patients as a way to overcome hypoxemia or for patient comfort. Also in STEMI patients, many of us have learned the mnemonic “MONA” to remember the treatments for acute coronary syndrome. MONA stands for morphine, oxygen, nitroglycerin, and aspirin. It is however important to remember that oxygen is a drug; just like any other drug, there are side effects.  Some of the best known side effects of hyperoxia are direct lung toxicity, peripheral vasoconstriction, and increase in production of reactive oxygen species.  The PROXI Trial (Perioperative Oxygen Fraction-Effect on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery) and the AVOID Trial (Air Versus Oxygen in Myocardial Infarction) showed increased long-term mortality and larger myocardial infarction size respectively in patients with supra-normal oxygen levels (hyperoxia). In this episode we will explore the effect of higher oxygen levels through in ICU and STEMI patients by reviewing two trials:

The Oxygen ICU Trial
The SOCCER Trial Read more →

July 2015 REBELCast

06 Jul
July 6, 2015

July 2015 REBELCastWelcome to the July 2015 REBELCast, where Swami, Matt, and I are going to talk oxygen. It is important to remember that oxygen is a drug, and just like any drug we prescribe to patients it has potential side effects.  Although there is a paucity of clinical trial data to support routine use of supplemental oxygen, most health care providers still put oxygen on patients for possible physiological benefits.  So with that introduction today we are going to specifically tackle:

  • Topic #1: The AVOID Trial – Supplemental O2 vs Room Air for STEMI
  • Topic #2: The FLORALI Trial – High Flow Nasal Cannula (HFNC) for Acute Hypoxemic Respiratory Failure Read more →