SWORBHP Ask MAC

Answer:

If the patient has experienced a hemorrhage, whether it be from trauma, GI bleed, or other cause, administering oxygen with normal saturation is not required and therefore not specifically mentioned in the Oxygen Therapy Standard as situations to administer high flow oxygen with normal Sp02.

Although oxygen-carrying capacity has been diminished due to hemoglobin loss, administering extra oxygen in the setting of normal Sp02 may not allow for additional oxygen-carrying ability. Only animal studies have been completed regarding administering oxygen in the setting of hemorrhage. However, they have not specifically targeted normal Sp02 and the effects on outcomes. We do know, and why in ROSC there is a targeted Sp02 written into the ROSC Medical Directive, that too much oxygen can be harmful. These risks include decreased vital organ blood flow due to vasoconstriction, increased bleeding if blood pressure is raised before hemostasis is achieved, and increased reactive oxygen species. What these hemorrhagic patients need is for the bleeding to be stopped (in the setting of trauma applying pressure or tourniquets, as appropriate) and rapid transport to hospital for treatment with blood products and definitive management of the cause of hemorrhage.

You will note under the Oxygen Therapy Standard that there are other conditions in which high flow oxygen is beneficial to patients regardless of their Sp02 such as carbon monoxide toxicity and scuba-diving related disorders. Here the additional 02 is displacing other gases being carried by the Hemoglobin and therefore acts in another manner to help with oxygen-carrying capacity, than in the setting of trauma.

Tisherman SA. Targeted Oxygen and Temperature Management During Hemorrhagic Shock: Is It All in the Timing? Crit Care Med. 2016 May;44(5):1024-5. doi: 10.1097/CCM.0000000000001494. PMID: 27083022.