Key messages

• Oxygen toxicity is mediated by reactive oxygen species, including superoxide, hydrogen peroxide, and hydroxyl radicals.

• Enzymatic and low-molecular-weight antioxidants protect cells from reactive oxygen species, but can be overwhelmed in hyperoxia.

• Arterial hypoxemia due to extreme V/Q mismatching (intrapulmonary shunt) requires high levels of inspired oxygen.

• Pulmonary oxygen toxicity resembles acute respiratory distress syndrome in its pathophysiology and morphology.

• Many drugs used clinically, including chemotherapeutic agents and corticosteroids, may exacerbate pulmonary oxygen toxicity.

• No clinically available agents (with the possible unproved exception of surfactants) mitigate human manifestations of oxygen toxicity.

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