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L’oxygénothérapie dans tous ces états ou comment administrer l’oxygène en 2014 ?

Oxygen therapy in all its forms: how to administer oxygen in 2014?

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Réanimation

Résumé

L’oxygénothérapie est indiquée en cas d’hypoxie tissulaire et doit être adaptée au degré d’hypoxémie. Du fait des risques secondaires à l’hypoxie tissulaire et des effets délétères potentiels de l’oxygénothérapie, des stratégies d’hypoxémie permissive ou, à l’inverse d’hyperoxie, ne peuvent pas être actuellement recommandées. Une prescription titrée et individualisée de l’oxygénothérapie semble indispensable. Les modalités d’administration et les interfaces évoluent et rendent l’oxygénothérapie plus efficace et confortable pour les patients. Ces évolutions ouvrent de nouvelles perspectives. En particulier, l’oxygénothérapie nasale à haut débit humidifiée et réchauffée prend une place croissante en réanimation. Elle pourrait éviter de recourir à la ventilation mécanique chez certains patients; mais d’autres études cliniques sont nécessaires pour en préciser les indications.

Abstract

Oxygen should be administrated in case of tissue hypoxia but has to be adapted to the level of hypoxemia. Taking into account the risks of tissue hypoxia as well as the potential adverse effects of oxygen therapy, permissive hypoxemia or conversely hyperoxia cannot be currently recommended. A targeted and individualized prescription seems essential. Oxygen delivery systems are changing and oxygen therapy becomes more efficient and comfortable for the patients. These evolutions open up new horizons. Consistently, heated and humidified nasal high-flow oxygen therapy takes an increasing place in the intensive care units. In selected patients, it could avoid the need for mechanical ventilation. Other clinical trials remain required to better clarify indications.

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  1. Centre de réanimation, hôpital Roger Salengro, centre hospitalier régional et universitaire de Lille, rue P. Decoulx, F-59037, Lille, France

    Y. Benzidi & L. Robriquet

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  2. L. Robriquet
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Benzidi, Y., Robriquet, L. L’oxygénothérapie dans tous ces états ou comment administrer l’oxygène en 2014 ?. Réanimation 23, 65–75 (2014). https://doi.org/10.1007/s13546-014-0839-8

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