July 2015 REBELCast

Welcome 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 July 2015 REBELCast Podcast Click here for Direct Download of Podcast Topic #1: The Avoid Trial - Supplemental 02 vs Room Air for STEMI Question #1: Does the administration of supplemental oxygen benefit patients who are normoxic with ST-Elevation Myocardial Infarction (STEMI)? Article #1: Stub D et al. Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction. Circulation May 2015 [epub ahead of print] Background #1: 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 (i.e reduced coronary blood flow, increased coronary vascular resistance, and production of reactive oxygen species) causing vasoconstriction and reperfusion injury. Ultimately, there are no studies evaluating the effects of supplemental oxygen therapy involving STEMI patients who are undergoing percutaneous coronary intervention. Taking all this information together there is a lot of uncertainty over the utility of routine supplemental oxygen therapy in acute myocardial infarction with no clear recommendations in normoxic patients in the most recent American Heart Association (AHA) STEMI guidelines. Despite this most patients with acute STEMI still have supplemental oxygen administered. What They Did #1: Compare supplemental oxygen therapy (face mask at 8 L/min) vs NO oxygen therapy in normoxic patients with STEMI (if O2 sat fell