From the Guidelines
High flow oxygen therapy itself does not directly cause hemoptysis (coughing up blood). While oxygen therapy is generally safe, extremely high concentrations of oxygen (particularly above 50-60%) administered for prolonged periods can potentially cause oxidative damage to lung tissues, leading to inflammation and potentially exacerbating underlying lung conditions 1. However, hemoptysis is not a recognized direct side effect of oxygen therapy. Instead, hemoptysis typically occurs due to underlying pathologies such as lung infections, bronchiectasis, tuberculosis, lung cancer, pulmonary embolism, or vasculitis.
The use of high-flow nasal oxygen (HFNO) therapy has been gaining widespread use in hospitalized patients, and its benefits include improved patient comfort and physiologic advantages, such as improved oxygenation and ventilation, better pulmonary compliance, reduced anatomical dead space, modest positive end-expiratory pressure, more efficient respiratory effort, reduced work of breathing, and secretion clearance 1.
If a patient develops hemoptysis while receiving oxygen therapy, the bleeding is most likely related to their underlying condition rather than the oxygen itself. Any patient experiencing hemoptysis should be evaluated promptly to identify and treat the underlying cause, regardless of whether they are receiving oxygen therapy. Oxygen therapy should be continued if clinically indicated, as hypoxemia itself can worsen underlying conditions that might cause hemoptysis. Key considerations for oxygen therapy include:
- Monitoring oxygen saturation levels to avoid hyperoxia
- Using the lowest effective oxygen concentration to minimize potential risks
- Regularly assessing patients for signs of respiratory deterioration or other complications
- Adjusting oxygen therapy as needed based on individual patient responses and clinical guidelines 1.
From the Research
High Flow Oxygen and Hemoptysis
- There is no direct evidence in the provided studies that high flow oxygen causes hemoptysis 2, 3, 4, 5, 6.
- Hemoptysis is the expectoration of blood from the lower respiratory tract, usually from bronchial arteries, and its most common causes are acute respiratory infections, cancer, bronchiectasis, and chronic obstructive pulmonary disease 2.
- High-flow oxygen should only be used in a few diseases such as carbon monoxide poisoning, cluster headaches, sickle cell crisis, and pneumothorax 3.
- The use of oxygen therapy, including high-flow oxygen, should be guided by the patient's oxygen saturation levels and clinical condition, and should be titrated to maintain oxygen saturation within a target range to prevent hyperoxemia 3, 5, 6.
- Supplemental oxygen, including high-flow oxygen, can have adverse effects and toxicity, and its use should be carefully monitored and managed 3, 6.