Oxygen therapy in the intensive care unit

Oxygen therapy is a crucial treatment method for maintaining vital signs in patients in the intensive care unit. However, several controversial issues have emerged regarding its clinical application. This article analyzes current research trends in oxygen therapy in the intensive care unit and provides guidance and recommendations. Relevant literature was retrieved from the Web of Science Core Collection, and keyword co-occurrence and highly cited literature hotspot analyses were conducted using VOSviewer 1.6.19 software. The key topics related to oxygen therapy in the intensive care unit primarily focus on four areas: oxygen therapy and mechanical ventilation in the intensive care unit, extracorporeal membrane oxygenation therapy for coronavirus disease 2019 and its role in reducing mortality, research on hypoxia and oxygen saturation monitoring, and oxygen inhalation therapy in the intensive care unit. The analysis of highly cited literature indicates that the main research hotspots regarding oxygen therapy used in the intensive care unit focus primarily on conservative oxygen therapy, high-flow nasal oxygen therapy, comparisons of high- and low-oxygenation strategies, and research on hyperbaric oxygen therapy. First, the potential of conservative oxygen therapy to reduce mortality rates in the intensive care unit has attracted considerable attention; however, further clinical studies are needed to validate its optimal parameters and suitable patient populations. Second, high-flow nasal oxygen therapy has been shown to be effective in alleviating respiratory distress and reducing the need for intubation. This therapy can deliver oxygen flows of up to 60 L/min, effectively improving respiratory distress and decreasing intubation demands. In patients subjected to high-risk extubation, the combination of high-flow nasal oxygen therapy and noninvasive ventilation significantly lowers the rate of reintubation, making the combined approach one of the best strategies to prevent respiratory failure after extubation in the intensive care unit. Third, there are differences between lower and higher oxygenation strategies regarding their effects on patient mortality, long-term outcomes, and clinician preferences; however, there is currently no clear evidence indicating which strategy is superior. Clinicians' preferences regarding various oxygenation targets may impact the design of future studies. Finally, hyperbaric oxygen therapy is recognized as an effective supportive treatment for various critical conditions and has significant application value in acute severe traumatic brain injury, cerebral resuscitation, and cardiopulmonary resuscitation. Currently, researchers are continually exploring the latest oxygen therapies in the intensive care unit. Several randomized controlled clinical trials investigating automated oxygen control, novel high-flow nasal oxygen therapy, and combined oxygen therapy are underway. The results of these trials should be closely observed. Overall, this article provides a systematic review and valuable reference for the scientific and rational application of oxygen therapy in the intensive care unit. Future research should focus on verifying the optimal parameters of conservative oxygen therapy, assessing oxygen needs in different patient populations, evaluating the long-term effects of oxygen treatment, and developing novel oxygen therapy technologies and devices.