PurposeHyperoxia may induce pulmonary injury and may increase oxidative stress. In this retrospective database study we aimed to evaluate the response to hyperoxia by intensivists in a Dutch academic intensive care unit.MethodsAll arterial blood gas (ABG) data from mechanically ventilated patients from 2005 until 2009 were extracted from an electronic storage database of a mixed 32-bed intensive care unit in a university hospital in Amsterdam. Mechanical ventilation settings at the time of the ABG tests were retrieved.ResultsThe results of 126,778 ABG tests from 5,498 mechanically ventilated patients were retrieved including corresponding ventilator settings. In 28,222 (22%) of the ABG tests the arterial oxygen tension (PaO2) was >16 kPa (120 mmHg). In only 25% of the tests with PaO2 >16 kPa (120 mmHg) was the fraction of inspired oxygen (FiO2) decreased. Hyperoxia was accepted without adjustment in ventilator settings if FiO2 was 0.4 or lower.ConclusionHyperoxia is frequently seen but in most cases does not lead to adjustment of ventilator settings if FiO2 <0.41. Implementation of guidelines concerning oxygen therapy should be improved and further research is needed concerning the effects of frequently encountered hyperoxia.

An emotion-oriented coping style is associated with worse mental health among Dutch ICU survivors. Additional research is needed in order to determine the precise role that coping style plays in the long-term recovery of ICU survivors. (PsycINFO Database Record

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Every year an estimated 5 to 8 million people die in low- and middle-income countries (LMICs) due to poor-quality care. Although quality improvements in healthcare facilities in LMICs are well-possible with tailored implementation plans, costs are often mentioned as a prohibiting factor. However, if quality improvements increase trust among patients, this might translate into increased visits and higher revenues for providers and enable them to further invest in quality. This paper assesses the potential business case of quality improvements in Sub-Saharan Africa (SSA). It focuses on both the public and private sector since the latter provides at least half of all health services in SSA. The analysis is based on a dataset including multiple assessments of quality and business performance indicators for almost 500 health facilities in Tanzania, Kenya, Ghana, Nigeria, and other SSA-countries. We studied the association between changes in quality assessment scores and subsequent changes in numbers of patient visits and staff as proxies for business growth. We found that quality improvements significantly improved business performance indicators, but only for those facilities that had already reached a certain level of quality to begin with. These findings suggest an S-shaped relationship between quality and business performance, leading to the existence of a "low-quality trap". Substantial financial investments might be needed initially to support facilities at the bottom of the distribution in reaching a basic level of quality, after which further quality investments may start translating into increased revenues, enhancing business performance.