Efficiency of goal-directed oxygen delivery in ICU patients

Jochmans, Sébastien; Vong, Ly-Van Phach; Rolin, Nathalie; Sy, Oumar; Chelly, Jonathan; Ellrodt, Olivier; Alphonsine, Jean-Emmanuel; Serbource‐Goguel, Jean; Abdallah, Razach Idriss; Weyer, Claire-Marie; Monchi, Mehran; Vinsonneau, Christophe

doi:10.5603/ait.a2016.0027

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…This was clearly demonstrated in a study looking at goal-directed oxygen delivery based on S pO 2 ; the investigators reported that the S pO 2 was in the prescribed range ϳ64% of the time. 64 This was consistent with findings from the 2015 British Thoracic Society national audit of oxygen therapy in hospitals in the United Kingdom (Table 4). 65 New systems for closed-loop control of oxygen therapy have been developed; initial findings indicate an improvement in controlling target saturation compared with manual titration; the use of these systems in clinical practice is rare, however, and there is a need to investigate the safety and efficacy of these devices in future trials.…”

Section: Oxygen Use In Critical Care Unitssupporting

confidence: 88%

Oxygen Use in Critical Illness

O’Driscoll

Smith

2019

Respir Care

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Oxygen is the most commonly used drug in critical care. However, because it is a gas, most clinicians and most patients do not regard it as a drug. For this reason, the use of medical oxygen over the past century has been driven by custom, practice, and "precautionary principles" rather than by scientific principles. Oxygen is a life-saving drug for patients with severe hypoxemia, but, as with all other drugs, too much can be harmful. It has been known for many decades that the administration of supplemental oxygen is hazardous for some patients with COPD and other patients who are vulnerable to retention of carbon dioxide (ie, hypercapnia). It has been recognized more recently that excessive oxygen therapy is associated with significantly increased mortality in critically ill patients, even in the absence of risk factors for hypercapnia. This paper provides a critical overview of past and present oxygen use for critically ill patients and will provide guidance for safer oxygen use in the future.

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Section: Oxygen Use In Critical Care Unitssupporting

confidence: 88%

Oxygen Use in Critical Illness

O’Driscoll

Smith

2019

Respir Care

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“…A study by Jochmans et al 14 reported that the measured S pO 2 for subjects in the ICU was within the predicted range only 64% of the time, and there was a clear trend toward hyperoxygenation in the mechanically ventilated subjects (odds ratio 1.3, 95% CI 1.22-1.38, P < .001). Furthermore, Rachamle et al 15 reported that 74% of mechanically ventilated subjects were exposed to excessive F IO 2 , which was correlated with a worse oxygenation index in a doseresponse manner.…”

Section: Discussionmentioning

confidence: 92%

Adherence to an Oxygen-Weaning Protocol in Mechanically Ventilated Adults in the Medical ICU

et al. 2020

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BACKGROUND: Patients undergoing mechanical ventilation in the ICU often receive supplemental oxygen. If not closely monitored, this may lead to hyperoxia. The use of an oxygen-weaning protocol may reduce this risk by pacing the titration of oxygen therapy to patient needs. ICU protocols are correlated with decreased mortality and length of stay and have great potential for cost savings. The goals of this study were to determine whether the oxygen-weaning protocol at a university-affiliated hospital was followed and to measure the length of time respiratory therapists took to wean patients once the oxygen-weaning parameters were met. METHODS: This was a retrospective chart review of subjects > 18 y of age admitted to the medical ICU who underwent intubation and mechanical ventilation and were placed on an oxygen therapy protocol. The following data were collected: demographics, arterial blood gases, the length of time to change F IO 2 after meeting weaning parameters, and the percent change in F IO 2. RESULTS: Data were collected from 30 subjects. The most common oxygen saturation parameter measured via pulse oximetry (S pO 2) used to initiate weaning oxygen was 92%. The mean 6 SD F IO 2 administered to subjects was 39.6 6 15.3% prior to extubation. The majority of subjects exhibited adequate oxygenation prior to extubation (mean 6 SD): P aO 2 99.3 6 6.7 mm Hg, S aO 2 95.1 6 26.9%. The mean 6 SD length of time to the first change in F IO 2 from the time a subject met the weaning criteria was 9.1 6 10.6 h (range 1-39 h; interquartile range 2-13 h). CONCLUSIONS: Subjects admitted to the medical ICU who were intubated, mechanically ventilated, and placed on the oxygen therapy protocol experienced a significant delay in oxygen weaning. Closer monitoring and adherence to the oxygen-weaning protocol should be considered to reduce the potential risk for hyperoxia. Key words: oxygen weaning; weaning protocols; oxygen titration protocol; patient-driven protocols; protocol adherence; weaning indices.

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“…Numerous international expert groups now advocate similarly. 1,9,11 Previous studies have identified inappropriate oxygen delivery to COPD patients in the pre-hospital and critical care settings, [12][13][14][15] including an association with increased mortality in the pre-hospital setting. 12 To our knowledge, no study has explored adverse outcomes for COPD patients delivered inappropriately high concentration oxygen in a ward setting.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of inpatient oxygen therapy in hypercapnic chronic obstructive pulmonary disease

Anderson

Hoang

Hay

et al. 2021

Internal Medicine Journal

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Background: High concentration oxygen therapy in hypercapnic chronic obstructive pulmonary disease (COPD) is associated with increased mortality. In ward-based patients with acute exacerbation of COPD and hypercapnia, this study examines oxygen prescription and the association between high concentration oxygen therapy and adverse outcome. Aims:To investigate the association between over-oxygenation and in-hospital adverse events.Methods: Inpatients with acute exacerbation of hypercapnic COPD at a tertiary Australian hospital over a 1-year period were retrospectively identified. Oxygen prescription and therapy was determined based on chart review. Over-oxygenation was defined as ≥10% of nursing chart observations recording oxygen delivery with oxygen saturation above 92%. A composite adverse outcome was defined as medical emergency team response, recommencement of non-invasive ventilation or death. The association between over-oxygenation and adverse outcome was assessed using survival analysis and conditional logistic regression modelling. Results:The study cohort comprised 106 unique patients and 157 admissions. Oxygen prescription was recorded in 132 (84%) and over-oxygenation occurred in 97 (62%) admissions. Over-oxygenation was higher in non-respiratory ward admissions (76% vs 57%, P = 0.03) and those without any form of oxygen prescription (84% vs 58%, P = 0.01). During follow up, 23 (22%) patients experienced an adverse event. Cox proportional hazards modelling found weak evidence for increased risk of an adverse event in over-oxygenated patients (hazard ratio 2.5; 95% confidence interval 0.8-7.3, P = 0.10). Conditional logistic regression, after matching on age, Charlson comorbidity category and length of follow up, found a similar estimate of association (hazard ratio 2.6; 95% confidence interval 0.8-8.7, P = 0.12).Conclusions: Over-oxygenation to hypercapnic COPD inpatients is common and rates of oxygen prescription are suboptimal. We found weak evidence of association between over-oxygenation and adverse events, likely due to low statistical power. Larger prospective studies are needed.

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Efficiency of goal-directed oxygen delivery in ICU patients

Cited by 5 publications

References 27 publications

Oxygen Use in Critical Illness

Oxygen Use in Critical Illness

Adherence to an Oxygen-Weaning Protocol in Mechanically Ventilated Adults in the Medical ICU

Evaluation of inpatient oxygen therapy in hypercapnic chronic obstructive pulmonary disease

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