Articles Vol. 67 No. 1 15/01/2026

ROLE OF HYPEROXIA IN THE TREATMENT OF COVID-19 AND OTHER PNEUMONIAS

Tran Viet Ha1, Phan Thanh Tai2
1 Trường Đại học Võ Trường Toản
2 Bệnh viện Đại học Võ Trường Toản
DOI: 10.52163/yhc.v67i1.4115
16 Views
12 Downloads
Keywords
Hyperoxia, oxygen therapy, COVID‑19, pneumonia, oxygen targets, ICU.
Abstract

Objectives: Synthesize contemporary evidence on the benefits and harms of hyperoxia-supraphysiologic arterial oxygen caused by high inspired oxygen-in adults with COVID‑19 and other pneumonias, and translate findings into pragmatic oxygen targets.

Methods: We consulted WHO and NIH living guidelines, professional society guidance, randomized trials of acute hypoxemic respiratory failure (including COVID‑19), and mechanistic reviews through October 17, 2025. Outcomes included mortality, organ dysfunction, ventilator‑ and oxygen‑free days, and oxygen‑related adverse events.

Results: Guidance converges on titrated oxygen that avoids both hypoxemia and sustained hyperoxia, typically targeting SpO2 92-96% for most adults and 88-92% for those at risk of hypercapnic respiratory failure. Large ICU trials (HOT‑ICU) and a COVID‑19-specific trial (HOT‑COVID) show no survival advantage with higher PaO2 targets (~90 mmHg) compared with lower targets (~60-70 mmHg). Mechanistic and clinical data link hyperoxia to oxidative lung injury, absorption atelectasis, impaired microcirculation, and CO2 retention in predisposed patients.

Conclusions: In COVID‑19 and other pneumonias, liberal oxygen strategies aiming for supranormal saturations confer no mortality benefit and may cause harm. Practice should prioritize goal‑directed, conservative oxygenation-aim for SpO2 92-96% (or 88-92% in CO2 retainers), reassess frequently, and wean FiO2 early with appropriate PEEP.

References
[1]
Hochberg C.H, Marik P.E. Oxygen Toxicity in Critically Ill Adults. Curr Anesthesiol Rep, 2021, 11:338-348. 10.1007/s40140-021-00481-0. Google Scholar
[2]
Singer M, Young P.J, Laffey J.G. Dangers of hyperoxia. Crit Care, 2021, 25: 440. 10.1186/s13054-021-03830-2. Google Scholar
[3]
Cooper J.S et al. Oxygen Toxicity. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023. Google Scholar
[4]
Amarelle L, Lecuona E, Sznajder J.I. Hyperoxia and Lungs: What We Have Learned. Front Med (Lausanne), 2021.10.3389/fmed.2021.678522. Google Scholar
[5]
World Health Organization. Clinical management of COVID-19: Living guideline. Geneva, 2023. Google Scholar
[6]
National Institutes of Health. COVID-19 treatment guidelines: Oxygenation and ventilation. Bethesda, MD: NIH, 2024. Google Scholar
[7]
O’Driscoll B.R et al. BTS Guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 2017, 72(Suppl 1). 10.1136/thoraxjnl-2016-209729. Google Scholar
[8]
Schjørring O.L et al. Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure. N Engl J Med, 2021, 384: 1301-1311. 10.1056/nejmoa2032510. Google Scholar
[9]
Nielsen F.M et al. Lower or higher oxygenation targets in patients with COVID-19 (HOT-COVID).Chest, 2025. 10.1016/j.chest.2024.08.055. Google Scholar
[10]
Douin D.J et al. Targeted Normoxemia and supplemental oxygen-free days in critically ill adults.JAMA Netw Open, 2025, 8. 10.1001/jamanetworkopen.2025.2093. Google Scholar