The causes and manifestations of lung injury from oxygen toxicity are the same as those for acute respiratory distress syndrome (ARDS).
Initial symptoms include dyspnea, nonproductive cough, chest pain beneath the sternum, and GI upset. As exposure to high levels of oxygen continues, the symptoms become more severe with decreased vital capacity, decreased compliance, crackles, and hypoxemia. Prolonged exposure to high oxygen levels damages lung tissues. Atelectasis, pulmonary edema, hemorrhage, and hyaline membrane formation result. Surviving this critical condition depends on correcting the underlying disease process and decreasing the oxygen amount delivered.
Prevent hypoxia by hyperoxygenating the patient with 100% oxygen with a manual resuscitation bag attached to an oxygen source. If the patient can take deep breaths, instruct him or her to do so three or four times with the existing oxygen delivery system before suctioning. If possible, monitor the heart rate or use a pulse oximeter while suctioning to assess tolerance of the procedure. Assess for hypoxia (e.g., increased heart rate and blood pressure, oxygen desaturation, cyanosis, restlessness, anxiety, dysrhythmias). Oxygen saturation below 90% by pulse oximetry indicates hypoxemia. If hypoxia occurs, stop the suctioning procedure. Using the 100% oxygen delivery system, reoxygenate the patient until baseline parameters return.