Article Reviews & Commentary
Article Reviews by Thomas J. Mancuso, MD, FAAP
Oxygen and Resuscitation; Beyond
the Myth.
Lefkowitz W Pediatrics 2002:109;517-518
This provocative commentary questions our uncritical use of oxygen during resuscitations. The author reviews the pulmonary toxicities associated with oxygen use, edema and fibrosis, and discounts these as not significant in the setting of resuscitation. Reperfusion injury is of more concern to the author. Hypoxic cells appear to undergo alterations in the metabolism, priming them to form free radicals once they are exposed to oxygen. Dr. Lefkowitz describes various metabolic changes noted in experimental resuscitation with 100% oxygen compared to room air resuscitation such as increased generation of oxygen free radicals, decreased CNS Na-K ATPase function and decreased dopamine metabolism. He does site studies which support the use of oxygen in resuscitation but points out the lack of appropriate control groups in these investigations. Human investigation on the use of less than100% oxygen during resuscitations have primarily been done in newborns, limiting their applicability to older children.
Commentary
I began this commentary with more than a little skepticism, but tI could not refute the author's argument that convincing evidence is lacking for the routine, uncritical use of oxygen for any and all resuscitations. The references included with this paper certainly are food for thought. I am not ready to use 21% oxygen in the next resuscitation in which I participate, but I nevertheless find the author's comments thought-provoking.
In addition to the references at the end of the paper, the commentary has a footnote for a review on the web of the history (beginning in 1774) of oxygen use which I include here.
http://www.mtsinai.org/pulmonary/papers/ox-hist/ox-hist-intro.html #include ./footer_include.iphtml