From underwater physiology to intensive care: oxygen tolerance unit at the bedside
By
Sylvain Diop
Maxime Théo Aparicio
Antoine Premachandra
Roman Mounier
July 11, 2026
Clinical Scorecard: From Aquatic Physiology to Critical Care: Implementing an Oxygen Tolerance Unit in Bedside Management
At a Glance
Category Detail
Condition Oxygen Tolerance in Critically Ill Patients Key Mechanisms Hyperoxia and O₂ toxicity mediated by reactive oxygen species (ROS); O₂ transport dynamics influenced by hemoglobin (Hb) and local O₂ gradients. Target Population Critically ill patients requiring oxygen therapy in the ICU. Care Setting Intensive Care Unit (ICU)
Key Highlights
RCTs show inconsistent results between restrictive and liberal oxygenation strategies. Hyperoxia can lead to O₂ toxicity, primarily affecting the lungs. PaO2 and SaO2/SpO2 are inadequate for defining optimal oxygenation targets. Guideline-Based Recommendations
Diagnosis
Assess tissue O2 exposure through arteriovenous O2 difference. Management
Consider both PaO2 and SaO2 in conjunction with pH and temperature for oxygen therapy. Monitoring & Follow-up
Monitor for signs of hyperoxia and O₂ toxicity, especially in patients on VA-ECMO. Risks
Excessive O2 administration may lead to pulmonary and systemic O₂ toxicity. Patient & Prescribing Data
Patients in the ICU requiring supplemental oxygen.
Oxygen therapy should be tailored to avoid hyperoxia while ensuring adequate tissue oxygenation.
Clinical Best Practices
Utilize a conservative target for SaO2 (e.g., 94–96%) to prevent hyperoxemia. Evaluate the effectiveness of O₂ delivery in relation to cellular O₂ consumption. Related Resources & Content
