Vai trò oxy cao áp (hyperoxia) trong điều trị COVID-19 và các bệnh lý viêm phổi khác

Oxygen therapy is fundamental in managing respiratory failure, particularly in pneumonia and COVID-19. While critical for preventing hypoxemia, the widespread practice of aggressive oxygenation leading to hyperoxia (supraphysiological PaO2/saturation from high FiO2) has garnered increasing scrutiny. Emerging evidence suggests that such liberal strategies may not improve mortality and could even cause harm due to potential pulmonary and extrapulmonary toxicity. This review aims to synthesize contemporary evidence on the benefits and harms of hyperoxia in adults with COVID-19 and other pneumonias. It seeks to consolidate current oxygen target recommendations, compare outcomes of lower versus higher oxygen strategies, and propose practical guidance tailored for the Vietnamese context, underscoring the critical need for optimized oxygen management.

Medical professionals, particularly critical care physicians, pulmonologists, emergency physicians, and nurses involved in the management of respiratory failure in patients with COVID-19 and other pneumonias.

This review synthesizes current evidence on the utility of hyperoxia, defined as supraphysiological arterial oxygen levels from high inspired oxygen, in the treatment of COVID-19 and other pneumonias. Utilizing data from WHO and NIH guidelines, professional society recommendations, randomized controlled trials (including HOT-ICU and HOT-COVID), and mechanistic reviews up to October 2025, the study assessed outcomes such as mortality, organ dysfunction, and oxygen-related adverse events. Findings consistently show that international guidelines advocate for titrated oxygen therapy, avoiding both hypoxemia and sustained hyperoxia. The recommended SpO2 targets are typically 92-96% for most adults and 88-92% for those at risk of hypercapnic respiratory failure. Crucially, large-scale ICU trials demonstrated no survival advantage with higher PaO2 targets (~90 mmHg) compared to lower targets (~60-70 mmHg). Mechanistically, hyperoxia is linked to oxidative lung injury, absorption atelectasis, impaired microcirculation, and CO2 retention, suggesting potential harm. The paper emphasizes that in COVID-19 and other pneumonias, liberal oxygen strategies aiming for supranormal saturations do not confer a mortality benefit and may even be detrimental. Clinical practice should therefore prioritize goal-directed, conservative oxygenation, focusing on achieving appropriate SpO2 ranges, frequent reassessment, and early weaning of FiO2 complemented by optimal PEEP and management of underlying hypoxemia causes. This approach aims to maximize patient benefit by minimizing the cumulative toxicity associated with excessive oxygen administration, providing pragmatic guidance for healthcare settings, especially in contexts like Vietnam.