The Effect of Prior Pulmonary Injury on the Rate of Development of Fatal Oxygen Toxicity

Abstract

The oxygen tolerance limits of normal man and experimental animals are largely known. 1 Winter PM Smith G The toxicity of oxygen. Anesthesiology. 1972; 37: 210-240 Crossref PubMed Scopus (123) Google Scholar However, toxic oxygen concentrations are seldom administered to patients without prior pulmonary injury, since the primary utility of high oxygen concentrations in clinical medicine is to overcome the systemic hypoxia arising from acute respiratory insufficiency. Virtually nothing is known about the pulmonary response to toxic oxygen concentrations in the presence of prior pulmonary damage. It would seem logical that such forms of injury would be at least additive. However, it is clinically evident that some patients in acute respiratory failure appear to be resistant to potentially toxic concentrations of oxygen. 2 Bendixen HH Egbert LD Hedley-Whyte J et al. Respiratory Care. CV Mosby Co, St. Louis1965 Google Scholar , 3 Nash G Blennerhassett JB Pontoppidan H Pulmonary lesions associated with oxygen therapy and artificial ventilation. N Engl J Med. 1967; 276: 368-374 Crossref PubMed Scopus (332) Google Scholar , 4 Northway Jr, WH Bosan RC Porter DY Pulmonary disease following respiratory therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967; 276: 357-368 Crossref PubMed Scopus (2233) Google Scholar Furthermore, experimental work indicates that phosgene gas 5 Ohlsson WTL A study on oxygen toxicity at atmospheric pressure. Acta Med Scand [Suppl]. 1947; 190: 1-93 Google Scholar and oxygen (prior intermittent exposure to hyperoxia), 6 Wright RA Weiss HS Hiatt EP et al. Risk of mortality in interrupted exposure to 100 per cent O2: Role of air vs lowered PO2. Am J Physiol. 1966; 210: 1015-1020 PubMed Google Scholar both cause structural changes in the lung and delay the rate of development of fatal oxygen toxicity at 1 atm.