From the Guidelines
A patient should not be on both a mechanical ventilator and oxygen therapy simultaneously, as the primary goal of mechanical ventilation is to maintain normoxaemia, and supplemental oxygen therapy should be titrated to achieve this goal while minimizing the risk of hyperoxia. The use of mechanical ventilation and oxygen therapy should be guided by the patient's specific clinical needs and oxygen requirements, with the goal of maintaining a SpO2 of 94% or higher while avoiding hyperoxia 1.
Key Considerations
- Mechanical ventilation is used to support breathing in patients who cannot breathe adequately on their own, and oxygen therapy is used to supplement oxygen levels in patients with hypoxemia.
- The primary goal of mechanical ventilation is to maintain normoxaemia, and supplemental oxygen therapy should be titrated to achieve this goal while minimizing the risk of hyperoxia.
- SpO2 monitoring can assist in the detection of hypoxaemia, but it does not improve overall patient outcomes or reduce morbidity and mortality 1.
- High-flow nasal oxygen therapy has been shown to be effective in managing acute hypoxemic respiratory failure and postextubation acute hypoxemic respiratory failure, and may be considered as an alternative to conventional oxygen therapy or noninvasive ventilation in certain patients 2.
Clinical Decision-Making
- The choice of respiratory support should be determined by a healthcare provider based on the patient's specific condition, oxygen levels, work of breathing, and overall clinical status.
- Clinicians should use the lowest possible fraction of inspired oxygen (FiO2) to achieve normoxia, and avoid using supplemental oxygen therapy in patients who are already receiving mechanical ventilation unless necessary to maintain adequate oxygenation.
- High-flow nasal oxygen therapy may be considered as a bridge to extubation or as a means of avoiding intubation in patients with acute respiratory failure, but its use should be guided by clinical judgment and patient-specific factors 2.
From the Research
Mechanical Ventilation and Oxygen Therapy
- There is no direct evidence to suggest that a patient should be on both a mechanical ventilator and oxygen therapy simultaneously, as the provided studies do not address this specific question 3, 4, 5, 6, 7.
- The studies focus on preventing hypothermia in patients, comparing different warming methods such as space blankets, heated humidification, and heat and moisture exchangers 3, 4, 5, 6, 7.
- Some studies discuss the use of heated-humidified breathing circuits and self-warming blankets to maintain core body temperature in patients under general anesthesia 6, 7.
- However, none of the studies provide information on the concurrent use of mechanical ventilators and oxygen therapy, making it difficult to determine the appropriateness of this combination 3, 4, 5, 6, 7.
Limitations of Current Evidence
- The available studies do not directly address the question of using both mechanical ventilation and oxygen therapy in patients 3, 4, 5, 6, 7.
- Further research is needed to investigate the effectiveness and safety of combining mechanical ventilation and oxygen therapy in patients 5, 6, 7.
- The current evidence is limited to preventing hypothermia and maintaining core body temperature in patients, and does not provide guidance on the use of mechanical ventilation and oxygen therapy together 3, 4, 5, 6, 7.