Critical Esay Essay

1701 words - 7 pages

The practice of administering inhaled high concentration oxygen to patients suffering chest pain is widespread, has been followed for about a century, and is advised in major textbooks of emergency care, general medicine, and cardiology. There remains an expectation amongst the general public and medical practitioners that oxygen simply forms part of the standard treatment of a ‘sick’ patient (Nicholson, 2004). A review of the evolution of supplemental oxygen therapy reveals that it is not evidence-based, and there is uncertainty about the benefits and safety. This paper will discuss the different approaches of the use of high concentration oxygen therapy for the client with acute chest ...view middle of the document...

These trials had few participants and mortalities and no substantive clinical outcomes. Despite these findings, indicating no favourable effects of high concentration oxygen in alleviating chest pain, the routine use of oxygen therapy continued unquestioned for the next 50 years (Kones, 2011).

In 2006, a study by Downs raised the potential dangers of high concentration oxygen therapy. Downs (2006) concluded that a patient at risk of developing hypoxemia (deprivation of adequate oxygen supply) is not protected by the administration of high concentration oxygen, and routine administration can have potentially adverse effects. He also noted the limitations of the trials, by Bourassa, Horvat et al. and Neill as being a lack of randomized controlled design, standardisation of duration of oxygen therapy or blinding in the schematic representation (ST) measurements, which limit the significance of their findings (as cited in Downs, 2006). Insufficient evidence from previously conducted trials, lead to the latest Cochrane review to determine whether oxygen therapy reduced, increased or had no effect on chest pain (Meier, Ebrahim, Otto, & Casas, 2013). Unfortunately, the authors could identify only four randomized controlled trials of 430 patients receiving either oxygen or room air (Meier, Ebrahim, Otto, & Casas, 2013). Sixteen deaths resulted, and death was “three times more likely to occur in the patients receiving oxygen” (Meier et al., 2013, pg 8). However, these deaths could not be conclusively attributed to the administration of oxygen due to the small number, but clearly supports the need for reassessment of high concentration oxygen therapy in patients suffering chest pain (Meier et al., 2013).

Most patients suffering chest pain are administered oxygen therapy by paramedics as part of their emergency treatment, before they have contact with a medical practicioner. The Australian Heart Foundation conducted a survey among Emergency Department physicians involved in the initial assessment of patients presenting with acute chest pain, and found that 96% of patients received high concentration oxygen therapy (Conti, 2009). The results showed that 50% of physicians believe that oxygen therapy decreases mortality, 25% thought it helps in pain relief and 25% believe it has no effect (Conti, 2009). However, these beliefs are not based on proven results, but on anecdotal evidence, expert opinion and continual widespread use (Conti, 2009). Professor Atar supports this by stating that “the use of oxygen for patients with angina is a cornerstone of treatment and undisputed” (2010, p. 152). Nonetheless, he has little evidence to support his claims, other than ‘custom and practice’ to assist the continuation of a particular therapy where there is solid physiological evidence and unreliable clinical evidence of harm, but a lack of proven benefit (Atar, 2010).

Pountain and Roffe disagree with Professor Atar’s claim arguing that oxygen does more harm than...

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