Are oxygen bars providing genuine health benefits or potential risks. How much more oxygen do these bars actually deliver compared to normal air. What are the potential health concerns associated with recreational oxygen use. Can oxygen therapy relieve stress, increase energy, and improve focus as claimed.

The Rise of Oxygen Bars: A New Health Trend?

Oxygen bars, a concept that gained popularity in the 1990s, are experiencing a resurgence across the country. These establishments essentially market and sell air, often making bold health claims about their inhaled product. The allure of these bars lies in their promises of numerous health benefits, ranging from stress relief to increased energy and improved focus.

But do these claims hold water? Let’s delve deeper into the world of recreational oxygen use and examine the potential benefits and risks associated with this trend.

Understanding Oxygen Concentration: What’s Really in the Air?

To comprehend the potential effects of oxygen bars, it’s crucial to understand the basics of oxygen concentration in the air we breathe:

• Normal air contains approximately 21% oxygen
• Oxygen bars claim to offer air with up to 95% oxygen concentration
• In reality, most oxygen bar products deliver only 35-40% oxygen

While this is indeed higher than the oxygen concentration in normal air, it’s important to note that the human body has evolved to function optimally in an atmosphere with 21% oxygen. Dr. Jason Turowski, a pulmonologist at the Cleveland Clinic Respiratory Institute, explains that once blood cells are saturated with oxygen, they cannot absorb any more, regardless of the concentration in the air.

Debunking Health Claims: Separating Fact from Fiction

Oxygen bars and canned oxygen products often make enticing health claims. These include:

1. Stress relief
2. Muscle ache reduction
3. Increased energy levels
4. Improved concentration and focus
5. Better sleep quality
6. Slowed aging process
7. Quick recovery from jet lag and hangovers

However, medical experts are skeptical about these claims. Dr. Norman H. Edelman, senior scientific advisor with the American Lung Association, suggests that many of the reported benefits may be attributed to the placebo effect rather than actual physiological changes.

Why Healthy Individuals Don’t Need Extra Oxygen

For healthy individuals, the body’s natural oxygen absorption mechanisms are typically sufficient. Dr. Turowski explains that conditions like hangovers or muscle pain are not related to oxygen deprivation, making supplemental oxygen unnecessary for these issues.

The one exception where extra oxygen might be beneficial is for athletes engaged in vigorous exercise. Football players, for instance, might benefit from oxygen after intense physical exertion. However, this doesn’t apply to the average individual going about their daily activities.

Potential Health Risks of Recreational Oxygen Use

While oxygen bars may seem harmless, there are several potential health concerns to consider:

1. Hygiene and Equipment Maintenance

Unlike medical-grade oxygen therapy, which uses sterile equipment, oxygen bars may not be subject to the same level of oversight. This raises questions about:

• The cleanliness of breathing devices
• Whether tubing is exchanged between users
• How non-medical grade oxygen concentrators are maintained
• If proper humidification is provided

These hygiene concerns could potentially lead to the growth of mold and bacteria, which could be problematic for individuals with existing lung conditions.

2. Risks for People with Certain Medical Conditions

Individuals with specific medical conditions should exercise caution when considering recreational oxygen use. These conditions include:

• Chronic Obstructive Pulmonary Disease (COPD)
• Emphysema
• Chronic bronchitis
• Cystic fibrosis
• Sarcoidosis
• Scleroderma
• Congenital heart or vascular disorders

For these individuals, using non-medical grade oxygen could potentially lead to complications or exacerbate existing conditions.

3. Concerns About Scented Oxygen

Many oxygen bars infuse their oxygen with various scents. While this may seem appealing, these scents are not designed to be inhaled in high concentrations. The potential effects on lung health, especially for those with conditions like asthma, are not fully understood and could pose risks.

The Science Behind Oxygen Absorption: Why More Isn’t Always Better

To understand why additional oxygen may not provide the claimed benefits, it’s important to delve into the science of how our bodies absorb and utilize oxygen:

The Oxygen Saturation Process

Our blood cells have a natural limit to how much oxygen they can carry. This is known as oxygen saturation. In healthy individuals, breathing normal air (21% oxygen) is sufficient to reach optimal oxygen saturation levels. Dr. Turowski uses an analogy to explain this concept: trying to add more oxygen to fully saturated blood cells is like attempting to squeeze more people onto an already packed subway car.

The Role of Hemoglobin

Hemoglobin, a protein in red blood cells, is responsible for carrying oxygen throughout the body. Under normal conditions, hemoglobin is almost fully saturated with oxygen. Increasing the oxygen concentration in the air doesn’t significantly increase the amount of oxygen hemoglobin can carry.

Alternatives to Oxygen Bars: Natural Ways to Boost Energy and Well-being

Instead of seeking out oxygen bars, there are numerous natural and proven ways to enhance your energy levels and overall well-being:

1. Regular exercise: Engage in physical activities that improve cardiovascular health and lung capacity.
2. Proper nutrition: Maintain a balanced diet rich in vitamins and minerals.
3. Adequate hydration: Drink plenty of water throughout the day.
4. Quality sleep: Ensure you get enough restful sleep each night.
5. Stress management: Practice relaxation techniques like meditation or yoga.
6. Spending time outdoors: Enjoy fresh air and nature, which can have natural mood-boosting effects.
7. Deep breathing exercises: Learn techniques to improve your natural breathing patterns.

These methods not only provide sustainable health benefits but also come without the potential risks associated with recreational oxygen use.

The Legal and Regulatory Landscape of Oxygen Bars

The regulation of oxygen bars and recreational oxygen products exists in a somewhat gray area:

FDA Stance on Recreational Oxygen

The U.S. Food and Drug Administration (FDA) considers oxygen a drug and medical device when used for medical purposes. However, the FDA’s oversight of recreational oxygen use is less clear. This lack of clear regulation raises questions about:

• Quality control standards for oxygen production
• Safety requirements for oxygen delivery systems
• Limitations on health claims made by oxygen bar operators

State and Local Regulations

Some states and local jurisdictions have implemented their own regulations for oxygen bars. These may include:

• Licensing requirements for operators
• Health and safety inspections
• Restrictions on allowed oxygen concentrations

However, these regulations are not uniform across the country, leading to inconsistencies in how oxygen bars are operated and monitored.

The Economics of Oxygen Bars: A Booming Industry?

Despite the skepticism from medical professionals, the oxygen bar industry has seen significant growth in recent years:

Market Size and Growth

While exact figures are difficult to pinpoint due to the fragmented nature of the industry, some estimates suggest that the global oxygen bar market could reach several hundred million dollars in the coming years. This growth is driven by factors such as:

• Increasing health consciousness among consumers
• The appeal of novel wellness experiences
• Marketing that capitalizes on the perceived benefits of oxygen therapy

Business Model and Profitability

Oxygen bars often operate with relatively low overhead costs, making them an attractive business venture for entrepreneurs. Revenue streams may include:

• Per-session fees for oxygen inhalation
• Sales of portable oxygen canisters
• Complementary services like aromatherapy or relaxation treatments

However, the long-term sustainability of this business model may depend on continued consumer interest and the absence of regulatory challenges.

The Future of Recreational Oxygen Use: Trends and Predictions

As the debate around recreational oxygen use continues, several trends and potential developments are worth considering:

Technological Advancements

Innovations in oxygen delivery systems and portability may lead to new products and applications. These could include:

• More efficient oxygen concentrators
• Smart devices that monitor and adjust oxygen delivery
• Integration with wearable health technology

Potential for Medical Research

While current evidence doesn’t support many claims made by oxygen bars, ongoing research into oxygen therapy could potentially uncover new applications or benefits. Areas of interest might include:

• Cognitive performance enhancement
• Recovery from specific types of physical exertion
• Management of certain medical conditions

Shifting Consumer Attitudes

As health and wellness trends evolve, consumer attitudes towards recreational oxygen use may change. Factors that could influence this include:

• Increased awareness of scientific evidence (or lack thereof)
• Emergence of new wellness trends that compete for consumer attention
• Changes in societal perceptions of health and well-being

In conclusion, while oxygen bars and recreational oxygen products continue to attract interest, the scientific community remains skeptical about their purported benefits for healthy individuals. As with any health trend, it’s crucial to approach these services with a critical eye and consult with healthcare professionals before incorporating them into your wellness routine. The future of recreational oxygen use will likely be shaped by a combination of scientific research, regulatory decisions, and evolving consumer preferences.

Getting ‘High’ on Air: Oxygen Energy Boost or Health Risk?

A new wave of oxygen bars is popping up across the country. Originally popular in the 1990s, these bars essentially market and sell air, and some make health claims for their inhaled product.

Claims for canned, inhaled oxygen are intoxicating, to say the least. Who doesn’t want to relieve stress, ease muscle aches, increase energy, concentrate and focus more effectively, sleep better, slow the aging process, and recover quickly from jet lag and hangovers?

If all of that sounds too good to be true, it undoubtedly is, which is why you should cast a doubtful eye on these oxygen products. Here’s what you need to know before you inhale.

Busting the Oxygen Bubble

Recreational oxygen therapy rests on a relatively simple premise: By delivering higher concentrations of oxygen than you would normally get from the air around you, you reap the above health rewards.

Just how much more oxygen do you get? While the air you breathe is made up of 21 percent oxygen, many oxygen bars and canned oxygen products claim to give you about 95 percent oxygen.

In reality, most of these products, especially those offered in oxygen bars, deliver only about 35 percent to 40 percent oxygen, says Frank LoVecchio, DO, MPH, co-medical director of the Banner Good Samaritan Poison and Drug Information Center at Banner Health and professor of emergency medicine at the University of Arizona College of Medicine in Phoenix.

While that’s still more oxygen than you get from the air around you, the truth is that healthy people just don’t need the extra oxygen. “Humans have evolved to live in an atmosphere with 21 percent oxygen,” says Jason Turowski, MD, pulmonologist with the Cleveland Clinic Respiratory Institute in Ohio.

“Once your blood gets enough oxygen, you can’t load any more onto your red blood cells,” Dr. Turowski says. He likens it to trying to squeeze more people onto an already-packed New York City subway car.

The one exception for otherwise healthy individuals? Athletes doing vigorous exercise, like football players; they might have just run 70 yards for a touchdown and then suck oxygen on the sidelines. “That oxygen will make that athlete feel better, but it won’t do anything for the average individual,” says Norman H. Edelman, MD, senior scientific advisor with the American Lung Association and professor of preventive medicine, internal medicine, and physiology and biophysics at the State University of New York at Stony Brook.

The numerous health claims these oxygen bars tout simply don’t hold merit, some experts say. “The reason for your hangover or muscle pain has nothing to do with hypoxia, a condition in which your body is deprived of oxygen, which is why it doesn’t make sense to give oxygen for these conditions,” Turowski notes.

Why then do so many people report feeling better after going to oxygen bars? “Blame the placebo effect,” Dr. Edelman says. It may be all in your head.

Potential Health Risks of Recreational Oxygen Use

Oxygen bars and the like may not pose major health threats for healthy people. “It might be better than going to a bar to drink,” Edelman says. But there are some aspects of recreational oxygen use that could pose health risks.

First, the cleanliness of breathing devices at oxygen bars needs to be considered. “Unlike medical-grade oxygen therapy where we provide sterile tubing, I’m not sure oxygen bars are subjected to any oversight, whether the tubing is exchanged between users, and how the non-medical grade oxygen concentrator is maintained or whether humidification is provided,” Turowski says.

Without fresh tubing or devices to sterilize that tubing, mold and bacteria could grow, which could be troublesome for people with existing lung problems. In fact, if you have medical conditions like chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, cystic fibrosis, sarcoidosis, scleroderma, or congenital heart or vascular disorders, it’s best to avoid oxygen bars. This is especially true if you’re using medical-grade oxygen.

“You could increase the likelihood of developing an unintended but possible complication like infection or exacerbation due to circumstances related to cleanliness and lack of standardization of equipment,” Turowski says.

Many oxygen bars infuse the oxygen with scents that aren’t designed to be in your lungs in high concentrations. Although the consequences of these scents aren’t known, there could be potential ill effects on your lungs, especially for people, like those with asthma, who might react to strong smells, Turowski says.

Although certainly trendy, oxygen bars and inhaled oxygen products may be little more than hot air for healthy people who aren’t climbing Mount Everest, where supplemental oxygen is required.

A better option? Take a walk through the woods and get a real sensory journey while inhaling Mother Nature’s fresh — and free — oxygen.

How Magnesium Keeps Your Heart Rhythm Healthy

Magnesium helps keep bones strong, nerves and muscles working properly, and blood sugar under control. It’s also necessary for maintaining a steady heartbeat…

By Mary Elizabeth DallasJune 13, 2023

6 Best Nutrient Pairings for Your Heart

These vitamin and mineral pairings add up to a healthier heart. A few dynamic duos: vitamin D and magnesium, iron and vitamin C, and more.

By Julie StewartJune 7, 2023

Tips for a Heart-Healthy Diet After Angioplasty

A heart-healthy diet will help keep your arteries clear after angioplasty. Learn about heart-healthy foods to eat as part of your heart disease treatment…

By Diana RodriguezJune 3, 2023

Taking Care of Your Heart Health in Your 20s, 30s, 40s, 50s, and 60s

One woman in the United States dies from heart disease every minute, and the risk increases with age. Find out how to best protect your heart in this …

By Sandra GordonMay 26, 2023

The 5 Best Questions to Ask Your Cardiologist

Cardiovascular disease is the No. 1 cause of death in the United States. Make the most of your time with a cardiologist by taking steps to prepare for…

By Meryl Davids LandauMay 2, 2023

The Best and Worst Diets for Heart Health

Despite their popularity, keto and paleo diets may not be great for long-term heart health — but the Mediterranean diet still ranks high.

By Kaitlin SullivanApril 28, 2023

The Heart Benefits From Weight Loss, Even if Some Is Regained

Behavioral programs can help people lower their blood pressure, cholesterol, and average blood sugar levels, even if the weight loss isn’t maintained….

By Don RaufMarch 30, 2023

Oxygen Toxicity – StatPearls – NCBI Bookshelf

Continuing Education Activity

Oxygen is vital to sustaining life. However, breathing oxygen at higher than normal partial pressure leads to hyperoxia and can cause oxygen toxicity or oxygen poisoning. The clinical settings in which oxygen toxicity occurs is predominantly divided into two groups; one in which the patient is exposed to very high concentrations of oxygen for a short duration, and the second where the patient is exposed to lower concentrations of oxygen but for a longer duration. These two cases can result in acute and chronic oxygen toxicity, respectively. The acute toxicity manifests generally with central nervous system (CNS) effects, while chronic toxicity has mainly pulmonary effects. Severe cases of oxygen toxicity can lead to cell damage and death. Those at particular risk for oxygen toxicity include hyperbaric oxygen therapy patients, patients exposed to prolonged high levels of oxygen, premature infants, and underwater divers. This activity reviews the etiology, presentation, evaluation, and management of oxygen toxicity and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition.

Objectives:

• Describe the basic pathophysiology of oxygen toxicity in the human body.

• Identify the presentation of a patient with oxygen toxicity, and duscuss potential differential diagnoses.

• Describe the treatment and management strategies for addressing oxygen toxicity.

• Summarize interprofessional team strategies for improving care coordination and communication to improve outcomes with management and treatment of oxygen toxicity.

Access free multiple choice questions on this topic.

Introduction

Oxygen is vital to sustain life.  However, breathing oxygen at higher than normal partial pressure leads to hyperoxia and can cause oxygen toxicity or oxygen poisoning [1].  The clinical settings in which oxygen toxicity occurs is predominantly divided into two groups; one in which the patient is exposed to very high concentrations of oxygen for a short duration, and the second where the patient is exposed to lower concentrations of oxygen but for a longer duration.  These two cases can result in acute and chronic oxygen toxicity, respectively.  The acute toxicity manifests generally with central nervous system (CNS) effects, while chronic toxicity has mainly pulmonary effects.   Severe cases of oxygen toxicity can lead to cell damage and death.  Those at particular risk for oxygen toxicity include hyperbaric oxygen therapy patients, patients exposed to prolonged high levels of oxygen, premature infants, and underwater divers.  [2]

Etiology

Extended exposure to above-normal oxygen partial pressures, or shorter exposures to very high partial pressures, can cause oxidative damage to cell membranes leading to the collapse of the alveoli in the lungs.  Pulmonary effects can present as early as within 24 hours of breathing pure oxygen.  Symptoms include pleuritic chest pain, substernal heaviness, coughing, and dyspnea secondary to tracheobronchitis and absorptive atelectasis which can lead to pulmonary edema.  Pulmonary symptoms typically abate 4 hours after cessation of exposure in the majority of patients.  CNS effects manifest with a multitude of potential symptoms.  Early symptoms and signs are quite variable, but twitching of perioral and small muscles of the hand is a fairly consistent feature.  If exposure to oxygen pressures is sustained tinnitus, dysphoria, nausea, and generalized convulsions can develop.   CNS toxicity is expedited by factors such as raised PCO2, stress, fatigue and cold [2].

Epidemiology

The CNS effects secondary to oxygen toxicity is known as the Bert effect. This can occur with hyperbaric oxygen therapy in a dose-dependent corelation[3].  The overall risk may be as frequent as 1 in 2000 to 3000 treatments. However, this risk may be as high as 1 in 200 at higher pressures (2.8 to 3.0 times normal atmospheric pressure or one atmosphere absolute (ATA)) and as low as 1 in 10,000 for treatment at 2 ATA (atmosphere absolute air) or less.  The incidence of displaying CNS symptoms secondary to oxygen toxicity is 2% with a seizure rate of 0.6%.

The phenomenon of pulmonary toxicity is commonly referred to as the Smith effect.  This can occur after prolonged exposure to oxygen >0.5 ATA.  The incidence of displaying pulmonary symptoms with oxygen toxicity is 5%.  Preterm newborns are at distinct risk for bronchopulmonary dysplasia and retrolental fibroplasia with prolonged exposure to high concentrations of oxygen.

Some chemicals such as the chemotherapeutic agent bleomycin also increase the risk of oxygen toxicity [4].

Pathophysiology

Oxygen-derived free radicals have been proposed as being the probable etiological cause in the development of oxygen toxicity. Free radicals are generated due to the mitochondrial oxidoreductive processes and also induced by the function of enzymes such as xanthine/urate oxidase at extra-mitochondrial sites, from auto-oxidative reactions, and by phagocytes during the bacterial killing. These free radicals create lipid peroxidations, especially in the cell membranes, subdue nucleic acids and protein synthesis, and mollify cellular enzymes. Continued exposure to high concentrations of oxygen results in heightened free radical production.  This may damage the pulmonary epithelium, inactivate the surfactant, form intra-alveolar edema, interstitial thickening, fibrosis, and ultimately lead to pulmonary atelectasis.[5] 

Histopathology

Oxygen toxicity stimulates the development of histological changes in the lung.  This consists of pulmonary edema, congestion, intra-alveolar hemorrhage, and pulmonary injury.   Tissue examination reveals that surfactant interruption and epithelial injury initiate the expanded expression of cytokines that activate inflammatory cells.  The heightened release of oxygen free radicals modifies normal endothelial function. Microscopic examination at high magnification display the alveoli in the lung filled with smooth to slight floccular pink material characteristic of pulmonary edema and congestion.  The capillaries in the alveolar walls are congested with many red blood cells.[6]

Toxicokinetics

100% oxygen can be tolerated at sea level for about 24-48 hours without any severe tissue damage.  Lengthy exposures produce definite tissue injury.  There is moderate carinal irritation on deep inspiration after 3-6 hours of exposure of 2 ATA, extreme carinal irritation with uncontrolled coughing after 10 hours, and finally, chest pain and dyspnea ensue.  In a majority of patients, these symptoms subside 4 hours after cessation of exposure.[7]

History and Physical

Symptoms may include disorientation, breathing problems, and visual changes such as myopia and cataract formation. System-based signs and symptoms include the following.

Central Nervous System 

• Headache

• Irritability and anxiety

• Dizziness

• Disorientation

• Hyperventilation

• Hiccups

• Cold shivering

• Fatigue

• Tingling in the limbs

• Visual changes such as blurring and tunnel vision 

• Tinnitus and Hearing disturbances

• Nausea

• Twitching  

• Tonic-clonic seizure 

Pulmonary Toxicity

• Mild tickle sensation on inhalation 

• Mild burning on inhalation 

• Uncontrollable coughing 

• Hemoptysis

• Dyspnea

• Rales 

• Fever

• Hyperemia of the nasal mucosa

• CXR shows inflammation and pulmonary edema

Eyes  

• In premature babies, retinopathy of prematurity and retrolental fibroplasia

• retinal edema

• Cataract formation (long-term exposure) [8]

Evaluation

Patients at risk for pulmonary oxygen toxicity should be monitored for oxygen saturation and elevated work of breathing. They can be evaluated by pulmonary function testing and chest x-ray which can show signs of acute respiratory distress syndrome (ARDS). Similarly, eye exams assessing acuity and looking for lens opacification can be done to detect early ocular oxygen toxicity. CNS toxicity manifests as described above and will often have associated tachycardia and diaphoresis. Aborting a hyperbaric exposure when these signs are present can prevent seizure occurrence [8].

Treatment / Management

Oxygen toxicity is managed by reducing the exposure to increased oxygen levels. The lowest possible concentration of oxygen that alleviates tissue hypoxia is optimal in patients with ARDS and decompensated neonates who are at particular risk for retrolental fibroplasia. Oxygen-induced seizures are self-limited and do not increase susceptibility to epilepsy. There is concern that oxygen-induced seizures could lead to damage but are felt to be benignant and similar to febrile seizures in children, where no particular treatment is available [8].

For hyperbaric oxygen treatments, those at high risk may benefit from anti-epileptic therapy, prolonged air breaks, and limited treatment pressure. Protocols for the avoidance of hyperoxia exist in fields where oxygen is breathed at higher-than-normal partial pressures.  This comprises underwater diving using compressed breathing gases, neonatal care, hyperbaric medicine, and human spaceflight. The present protocols have diminished the incidence of seizures due to oxygen toxicity, with pulmonary and ocular damage being mainly confined to the problems of managing premature infants. Oxygen toxicity seizures during hyperbaric therapy have also been curtailed by the introduction of “air breaks” (intermittent air-breathing while in the hyperbaric environment). This intervention may lower risk by a factor of 10. [9]

Deep divers (diving below 185 feet) require breathing mixtures that contain less than 21% oxygen to reduce toxicity risk. At these depths, the mixture is changed from nitrogen to helium as well.   Underwater seizures require immediate ascent as the risk of pulmonary barotrauma, and decompression illness is offset by the extraordinarily high risk of fatal drowning [10].

Differential Diagnosis

Several conditions can be mistaken for oxygen toxicity.  Typically diagnosis is made clinically and can be confirmed with PaO2 (arterial oxygen levels).  The following conditions must be ruled out when clinically evaluating for oxygen toxicity [11]:

• Carbon dioxide narcosis

• Carbon monoxide poisoning

• Hyperventilation

• Envenomation or toxin ingestion

• Cerebrovascular event

• Migraine

• Seizure disorder

• Infection

• Multiple sclerosis

• Hypoglycemia

Treatment Planning

Treatment for oxygen toxicity is purely symptomatic, therefore it is imperative to monitor for early recognition of toxicity . It should be remembered that the sudden stoppage of oxygen at the onset of toxicity may at times aggravate symptoms.  The onset and rate of progression of oxygen toxicity can be influenced by a variety of conditions, procedures and drugs. Induction of antioxidant enzymes, such as superoxide dismutase, by exposure to non-lethal levels of hyperoxia/hypoxia isoloated or conjointly has been tried successfully in animals and is in the process of being evaluated in man [12]. It is thought that this may lead to the progression of tolerance to subsequent hyperoxic exposure.  Exogenous antioxidants, notably vitamin E and C have been found to lower the prevalence of retrolental fibroplasia in premature infants on hyperoxic therapy [13].

Prognosis

For adults, although central nervous system oxygen toxicity may lead to incidental injury, studies show that with the removal of the inciting agent no long term neurological damage occurs [14].  Damage due to oxygen-induced pulmonary toxicity is reversible in most adults.

For infants, those who have survived following an incidence of bronchopulmonary dysplasia will ultimately recover near-normal lung function, since lungs continue to grow during the first 5–7 years.   Nevertheless, they are likely to be more vulnerable to respiratory infections for the rest of their lives, and the harshness of later infections is often greater than that in their peers [15].

Retinopathy of prematurity (ROP) in infants frequently reverses without intervention and eyesight may be normal in later years. When the disease has advanced to the stages requiring surgery, the results are generally good for the treatment of stage 3 ROP, but are much worse for the later stages. Although surgery is usually successful in restoring the anatomy of the eye, damage to the nervous system by the progression of the disease leads to comparatively poorer results in restoring vision. The presence of other complicating diseases also reduces the likelihood of a favourable outcome [16].

Complications

Oxygen toxicity can cause a variety of complications affecting multiple organ systems.  CNS complications primarily include tonic-clonic convulsions and amnesia.  Pulmonary sequelae range from mild tracheobronchitis and absorptive atelectasis to diffuse alveolar damage that is indistinguishable from ARDS.   Ocular complications consist of reversible myopia, delayed cataract formation, and in children, retrolental fibroplasia.  Serous otitis media and dysbaric osteonecrosis have also been observed.  In patients with chronic obstructive pulmonary disease (COPD), status asthmaticus, weakness of the respiratory muscles (e.g., from polyneuritis, poliomyelitis, or myasthenia gravis) and in those with central respiratory depression from narcotic poisoning, head injury, or raised intracranial tension, oxygen toxicity can cause carbon dioxide narcosis secondary to a loss in the hypoxemic drive and decrease in ventilation [17].

Deterrence and Patient Education

The major limitation facing a much more abundant clinical use of hyperoxia is its probable toxicity and the relatively limited margin of safety that exists between its effective and toxic doses. However, an alertness of the toxic effects of oxygen and a familiarity with safe pressure and duration, limits its application.  Moreover, the capacity to carefully manage its dose provides a sufficient basis for broadening the current list of clinical indications for its use. The most obvious toxic manifestations of oxygen are those exerted on the respiratory system and central nervous system. 

Pearls and Other Issues

There is wide variability in susceptibility to oxygen toxicity. Increased seizure risk is linked to retention of carbon dioxide, underwater immersion, exposure to cold, and exercise.  Scuba divers use breathing gases containing up to 100% oxygen (e.g., enriched air nitrox, closed circuit rebreathers) and should have specific training in safe use. In recent years, oxygen has become available for recreational use in oxygen bars. The FDA warns those suffering from problems such as heart or lung disease not to use oxygen bars [18].

Enhancing Healthcare Team Outcomes

Although there is a steadily growing body of data on hyperoxia, the quantity of high-quality information on its clinical effects trails behind. The present list of evidence-based indications for hyperoxia is much more limited than the broad spectrum of clinical conditions such as impaired oxygen delivery, cellular hypoxia, tissue edema, inflammation, and infection that can potentially be mitigated by oxygen therapy.

The easy accessibility of normobaric hyperoxia calls for a much more dynamic attempt to characterize its potential clinical efficacy. The all-around beneficial profile of actions of hyperoxia justifies an appropriately funded prospective research approach that will establish the efficacy of a safe range of nontoxic doses and treatment duration.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P. Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Ann Intensive Care. 2015 Dec;5(1):42. [PMC free article: PMC4653126] [PubMed: 26585328]

2.

Thomson L, Paton J. Oxygen toxicity. Paediatr Respir Rev. 2014 Jun;15(2):120-3. [PubMed: 24767867]

3.

Camporesi EM. Side effects of hyperbaric oxygen therapy. Undersea Hyperb Med. 2014 May-Jun;41(3):253-7. [PubMed: 24984321]

4.

Banham ND. Oxygen toxicity seizures: 20 years’ experience from a single hyperbaric unit. Diving Hyperb Med. 2011 Dec;41(4):202-10. [PubMed: 22183697]

5.

Matalon S, Nesarajah MS, Farhi LE. Pulmonary and circulatory changes in conscious sheep exposed to 100% O2 at 1 ATA. J Appl Physiol Respir Environ Exerc Physiol. 1982 Jul;53(1):110-6. [PubMed: 6811521]

6.

Brock TG, Di Giulio C. Prolonged exposure to hyperoxia increases perivascular mast cells in rat lungs. J Histochem Cytochem. 2006 Nov;54(11):1239-46. [PubMed: 16899761]

7.

Wingelaar TT, van Ooij PAM, Brinkman P, van Hulst RA. Pulmonary Oxygen Toxicity in Navy Divers: A Crossover Study Using Exhaled Breath Analysis After a One-Hour Air or Oxygen Dive at Nine Meters of Sea Water. Front Physiol. 2019;10:10. [PMC free article: PMC6355711] [PubMed: 30740057]

8.

Chawla A, Lavania AK. OXYGEN TOXICITY. Med J Armed Forces India. 2001 Apr;57(2):131-3. [PMC free article: PMC4925834] [PubMed: 27407317]

9.

Domachevsky L, Rachmany L, Barak Y, Rubovitch V, Abramovich A, Pick CG. Hyperbaric oxygen-induced seizures cause a transient decrement in cognitive function. Neuroscience. 2013 Sep 05;247:328-34. [PubMed: 23732232]

10.

Farmery S, Sykes O. Neurological oxygen toxicity. Emerg Med J. 2012 Oct;29(10):851-2. [PubMed: 21900296]

11.

Ni YN, Wang YM, Liang BM, Liang ZA. The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis. BMC Pulm Med. 2019 Feb 26;19(1):53. [PMC free article: PMC6390560] [PubMed: 30808337]

12.

Neal M, Richardson JR. Time to get Personal: A Framework for Personalized Targeting of Oxidative Stress in Neurotoxicity and Neurodegenerative Disease. Curr Opin Toxicol. 2018 Feb;7:127-132. [PMC free article: PMC6157269] [PubMed: 30272040]

13.

Stone CA, McEvoy CT, Aschner JL, Kirk A, Rosas-Salazar C, Cook-Mills JM, Moore PE, Walsh WF, Hartert TV. Update on Vitamin E and Its Potential Role in Preventing or Treating Bronchopulmonary Dysplasia. Neonatology. 2018;113(4):366-378. [PMC free article: PMC5980725] [PubMed: 29514147]

14.

Xiao Y, Xiong T, Meng X, Yu D, Xiao Z, Song L. Different influences on mitochondrial function, oxidative stress and cytotoxicity of antibiotics on primary human neuron and cell lines. J Biochem Mol Toxicol. 2019 Apr;33(4):e22277. [PubMed: 30597674]

15.

Luo HJ, Wang LY, Chen PS, Hsieh WS, Hsu CH, Peng S, Jeng SF. Neonatal respiratory status predicts longitudinal respiratory health outcomes in preterm infants. Pediatr Pulmonol. 2019 Jun;54(6):814-821. [PubMed: 30839172]

16.

Ahmad M, Patnaik J, Thevarajah T, Cathcart J, Jung J, Singh J, Braverman R, Lynch A, McCourt E. Delayed resolution of retinopathy of prematurity. J AAPOS. 2019 Apr;23(2):90.e1-90.e6. [PubMed: 30772472]

17.

Wingelaar TT, van Ooij PAM, van Hulst RA. Oxygen Toxicity and Special Operations Forces Diving: Hidden and Dangerous. Front Psychol. 2017;8:1263. [PMC free article: PMC5524741] [PubMed: 28790955]

18.

Gill M, Natoli MJ, Vacchiano C, MacLeod DB, Ikeda K, Qin M, Pollock NW, Moon RE, Pieper C, Vann RD. Effects of elevated oxygen and carbon dioxide partial pressures on respiratory function and cognitive performance. J Appl Physiol (1985). 2014 Aug 15;117(4):406-12. [PubMed: 24947022]

Disclosure: Jeffrey Cooper declares no relevant financial relationships with ineligible companies.

Disclosure: Prabin Phuyal declares no relevant financial relationships with ineligible companies.

Disclosure: Neal Shah declares no relevant financial relationships with ineligible companies.

Oxygen content in the atmosphere.

Information for gas rescuers

The quality of the air necessary to support the life processes of all living organisms on Earth is determined by the content of oxygen in it.
Consider the dependence of air quality on the percentage of oxygen in it using the example of Figure 1.

Fig. 1 Percentage of oxygen in air

Favorable level of oxygen in the air

Zone 1-2: this level of oxygen content is typical for ecologically clean areas, forests. The oxygen content in the air on the ocean can reach 21.9%

Comfort level of oxygen in the air

Zone 3-4: is limited by the legal minimum indoor oxygen standard (20.5%) and the fresh air “reference” (21%). For urban air, an oxygen content of 20.8% is considered normal.

Insufficient level of oxygen in the air

Zone 5-6: is restricted to the minimum allowable oxygen level when a person can be without breathing apparatus (18%).
A person’s stay in rooms with such air is accompanied by rapid fatigue, drowsiness, decreased mental activity, and headaches.
Prolonged stay in rooms with such an atmosphere is dangerous to health.

Dangerously low oxygen levels in the air

Zone 7 onwards: at an oxygen content of 16% dizziness, rapid breathing, 13% loss of consciousness, 12% irreversible changes in the functioning of the body, 7% death.
An atmosphere unsuitable for breathing is also characterized not only by exceeding the maximum permissible concentrations of harmful substances in the air, but also by insufficient oxygen content.
Due to the different definitions that are given to the concept of “insufficient oxygen content”, gas rescuers very often make mistakes when describing gas rescue work. This happens, including as a result of the study of charters, instructions, standards and other documents containing an indication of the oxygen content in the atmosphere.
Consider the differences in the percentage of oxygen in the main regulatory documents.

    1. Oxygen content less than 20%.
Gas hazardous work is carried out when the oxygen content in the air of the working area is less than 20%.
– Standard instructions for organizing the safe conduct of gas hazardous work (approved by the USSR Gosgortekhnadzor on February 20, 1985):
1.5. Gas-hazardous work includes … with insufficient oxygen content (volume fraction below 20%).
– Standard instruction for the organization of the safe conduct of gas hazardous work at the enterprises of oil products supply TOI R-112-17-95 (approved by order of the Ministry of Fuel and Energy of the Russian Federation of July 4, 1995 N 144):
1.3. Gas hazardous work includes … when the oxygen content in the air is less than 20% by volume.
– National standard of the Russian Federation GOST R 55892-2013 “Objects of small-tonnage production and consumption of liquefied natural gas. General technical requirements” (approved by order of the Federal Agency for Technical Regulation and Metrology dated December 17, 2013 N 2278-st):
K.1 Gas-hazardous work includes work … when the oxygen content in the air of the working area is less than 20%.

    2. The oxygen content of is less than 18%.
Gas rescue operations are carried out when the oxygen content is less than 18%.
– Regulations on the gas rescue formation (approved and put into effect by the First Deputy Minister of Industry, Science and Technology Svinarenko A.G. on 06/05/2003; agreed: Federal Mining and Industrial Supervision of the Russian Federation on 05/16/2003 N АС 04-35 / 373).
3. Gas rescue operations … in conditions of reducing the oxygen content in the atmosphere to a level of less than 18 vol.% …
– Guidelines for the organization and conduct of emergency rescue operations at the enterprises of the chemical complex (approved by the UAC No. 5/6 protocol No. 2 of 07/11/2015).
2. Gas rescue work … in conditions of insufficient (less than 18%) oxygen content …
– GOST R 22.9.02-95 Safety in emergency situations. Modes of activity of rescuers using personal protective equipment in the aftermath of accidents at chemically hazardous facilities. General requirements (adopted as an interstate standard GOST 22.9.02-97)
6.5 At high concentrations of OHV and insufficient oxygen content (less than 18%) in the focus of chemical contamination, use only insulating respiratory protective equipment.

    3. The oxygen content of is less than 17%.
Do not use filter RPE if the oxygen content is less than 17%.
– GOST R 12.4.233-2012 (EN 132:1998) System of labor safety standards. Personal respiratory protection. Terms, definitions and designations (approved and put into effect by order of the Federal Agency for Technical Regulation and Metrology dated 29November 2012 N 1824-st)
2. 87… oxygen deficient atmosphere: Ambient air containing less than 17% oxygen by volume in which filtered RPE cannot be used.
– Interstate standard GOST 12.4.299-2015 System of labor safety standards. Personal respiratory protection. Recommendations for the selection, application and maintenance (put into effect by order of the Federal Agency for Technical Regulation and Metrology dated June 24, 2015 N 792-st)
B.2.1 Oxygen deficiency. If the analysis of environmental conditions indicates the presence or possibility of oxygen deficiency (volume fraction less than 17%), then filter-type PPE is not used …
– Decision of the Commission of the Customs Union of December 9, 2011 N 878 On the adoption of the technical regulation of the Customs Union “On the safety of personal protective equipment”
7) … it is not allowed to use filtering means of personal respiratory protection when the content of oxygen in the inhaled air is less than 17 percent
– Interstate standard GOST 12. 4.041-2001 System of labor safety standards. Means of individual protection of respiratory organs filtering. General technical requirements (put into effect by the Decree of the State Standard of the Russian Federation of September 19, 2001 N 386-st)
1 … filtering means of personal respiratory protection designed to protect against aerosols, gases and vapors harmful to health and their combinations in the ambient air, provided that the oxygen content in it is not less than 17 vol. %.

oxygen calculation

ADD A LITTLE OXYGEN | Nauka i Zhizn

How often, after a tiring working day, we are suddenly overwhelmed by insurmountable fatigue, the head becomes heavy, thoughts are confused, drowsiness piles up … Such an indisposition is not considered a disease, but nevertheless it greatly interferes with a normal life and work. Many rush to take a headache pill and go to the kitchen to make a cup of strong coffee. Or maybe you just do not have enough oxygen?

Diagram of the oxygen content in the air.

Obtaining air enriched with oxygen.

‹

›

View full size

As you know, the earth’s atmosphere is 78% chemically neutral gas – nitrogen, almost 21% is the basis of all living things – oxygen. But it was not always so. As modern studies show, 150 years ago, the oxygen content in the air reached 26%, and in prehistoric times, dinosaurs breathed air in which there was more than a third of oxygen. Today, all the inhabitants of the globe suffer from a chronic lack of oxygen – hypoxia. It is especially difficult for city dwellers. So, underground (in the subway, in passages and underground shopping centers), the concentration of oxygen in the air is 20.4%, in high-rise buildings – 20.3%, and in a crowded car of ground transport – only 20.2%.

It has long been known that increasing the oxygen concentration in the inhaled air to the level established by nature (about 30%) has a beneficial effect on human health. No wonder astronauts on the International Space Station breathe air containing 33% oxygen.

How to protect yourself from hypoxia? In Japan, so-called “oxygen bars” have recently become popular among residents of large cities. This is a kind of cafe – everyone can look into them and, for a small fee, breathe in oxygen-enriched air for 20 minutes. Customers at the “oxygen bars” – more than enough, and their number continues to grow. Many of them are young women, but there are also older people.

Until recently, Russians did not have the opportunity to be a visitor to a Japanese oxygen bar. But in 2004, the Japanese Oxycool-32 oxygen enrichment device manufactured by YMUP/Yamaha Motors group enters the Russian market. Since the technology used to create the device is really new and unique (an international patent is being filed for it now), readers will certainly be interested in learning more about it.

The operation of the new Japanese device is based on the principle of membrane gas separation. Atmospheric air at normal pressure is supplied to the polymer membrane. The thickness of the gas separation layer is 0.1 micrometer. The membrane is made of a high molecular weight material: at high pressure it adsorbs gas molecules, and at low pressure it releases them. Gas molecules penetrate into the spaces between the polymer chains. “Slow gas” nitrogen permeates through the membrane at a slower rate than “fast” oxygen. The amount of “delay” of nitrogen depends on the difference in partial pressures on the outer and inner surfaces of the membrane and the speed of the air flow. On the inner side of the membrane, the pressure is reduced: 560 mm Hg. Art. The pressure ratio and flow rate are chosen so that the concentration of nitrogen and oxygen at the outlet is 69% and 30% respectively. Oxygen-enriched air exits at a rate of 3 l/min.

The gas separation membrane traps microorganisms and pollen in
air. In addition, the air stream can be passed through a solution of aromatic
essences, so that a person will breathe air not only purified from bacteria,
viruses and pollen, but also having a pleasant mild aroma.

The device “Oxycool-32” has a built-in air ionizer, similar to the well-known in Russia “Chizhevsky’s chandelier”. Under the action of ultraviolet radiation, electrons are emitted from the titanium tip. Electrons ionize oxygen molecules, forming negatively charged “air ions” in the amount of 30,000-50,000 ions per cubic centimeter. “Airions” normalize the potential of the cell membrane, thereby providing a general strengthening effect on the body. In addition, they charge dust and dirt suspended in the city air in the form of a fine aerosol. As a result, the dust settles and the air in the room becomes much cleaner.

By the way, this small-sized device can also be connected to a car power source, which will allow the driver to enjoy fresh air, even while standing in a multi-kilometer traffic jam on Moscow’s Garden Ring.

The main oxygen carrier in the body is hemoglobin, which is found in red blood cells – erythrocytes. The more oxygen erythrocytes “deliver” to the cells of the body, the more intense the metabolism as a whole: “burn” fats, as well as substances harmful to the body; lactic acid is oxidized, the accumulation of which in the muscles causes symptoms of fatigue; new collagen is synthesized in skin cells; blood circulation and respiration improve. Therefore, an increase in the oxygen concentration in the inhaled air relieves fatigue, drowsiness and dizziness, relieves muscle and lower back pain, stabilizes blood pressure, reduces shortness of breath, improves memory and attentiveness, improves sleep, relieves hangover syndrome. Regular use of the device will help to lose weight and rejuvenate the skin. Oxygen therapy is also useful for asthmatics, patients suffering from chronic bronchitis, severe forms of pneumonia.

Regular inhalation of air enriched with oxygen will prevent hypertension, atherosclerosis, stroke, impotence, and in the elderly – respiratory arrest during sleep, which sometimes leads to death. Supplemental oxygen will also serve well for diabetic patients – it will make it possible to reduce the number of daily insulin injections.

“Oxycool-32” will undoubtedly find application in sports clubs, hotels, beauty salons, offices, entertainment complexes. But this does not mean at all that the new device is not suitable for individual use.