Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation

Semler, Matthew W.; Casey, Jonathan D; Lloyd, Bradley D.; Hastings, Pamela G.; Hays, Margaret; Stollings, Joanna L.; Buell, Kevin G; Brems, J.H.; Qian, Edward T; Seitz, Kevin P.; Wang, Li; Lindsell, Christopher J.; Freundlich, Robert E.; Wanderer, Jonathan P.; Han, Jin H.; Bernard, Gordon R.; Self, Wesley H.; Rice, Todd W.

doi:10.1056/nejmoa2208415

Cited by 99 publications

(82 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In healthcare, including anaesthesiology and intensive care medicine, doing less is often just as good, or better, for patient outcomes. Examples from recent publications include lower haemoglobin targets as an infusion trigger [ 31 ], lower targets for oxygen saturation during mechanical ventilation [ 32 ] and lower intraoperative blood pressure [ 33 ]. It is estimated that only 32% of clinical practice is anaesthesiology is backed by level I or II evidence (i.e.…”

Section: Medical Overuse and Research Wastementioning

confidence: 99%

Anaesthesia and environment: impact of a green anaesthesia on economics

Kampman

Weiland

2023

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of reviewThe excessive growth of the health sector has created an industry that, while promoting health, is now itself responsible for a significant part of global environmental pollution. The health crisis caused by climate change urges us to transform healthcare into a sustainable industry. This review aims to raise awareness about this issue and to provide practical and evidence-based recommendations for anaesthesiologists.Recent findingsWe offer seven recommendations for anaesthesiologists that want to transform their own practice.Use total intravenous anaesthesia over inhalation-based anaesthesia.Use ultra-low fresh gas flow (<0.5 l min−1) during inhalation based anaesthesia and higher flows (4–6 l min−1) during total intravenous anaesthesia.Anaesthetic gas capturing technology may have limited environmental benefit, while it increases cost.In the clinical setting, epidural or intravenous analgesia during labour is preferred over nitrous oxide inhalation.Properly designed air treatment systems save energy and reduce cost.Unoccupied set-back of air treatment systems can save up to 70% of energy.Reusable equipment is almost always associated with a lower environmental impact and lower costs compared with single-use disposables.SummaryThis review offers evidence-based recommendations, along with their financial impact, to improve the sustainability of anaesthesiology practice in the operating room.

show abstract

Section: Medical Overuse and Research Wastementioning

confidence: 99%

Anaesthesia and environment: impact of a green anaesthesia on economics

Kampman

Weiland

2023

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…Semler et al showed neither the mortality nor the ventilator-free days differed with an SpO 2 ranging between 88% and 100%. 16 Alternatively, the downstream venous oxygen saturation (eg, mixed venous saturation, Jugular venous oxygen saturation [SjvO 2 ]) or tissue oxygenation had been explored as complementary monitoring targets. Venous saturation reflects the balance between oxygen delivery and consumption, while tissue oxygen indices indicate oxygen availability.…”

Section: Basic Monitoring Gas Exchangementioning

confidence: 99%

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Roshdy

2023

J Intensive Care Med

View full text Add to dashboard Cite

The increased application of mechanical ventilation, the recognition of its harms and the interest in individualization raised the need for an effective monitoring. An increasing number of monitoring tools and modalities were introduced over the past 2 decades with growing insight into asynchrony, lung and chest wall mechanics, respiratory effort and drive. They should be used in a complementary rather than a standalone way. A sound strategy can guide a reduction in adverse effects like ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, patient-ventilator asynchrony and helps early weaning from the ventilator. However, the diversity, complexity, lack of expertise, and associated cost make formulating the appropriate monitoring strategy a challenge for clinicians. Most often, a big amount of data is fed to the clinicians making interpretation difficult. Therefore, it is fundamental for intensivists to be aware of the principle, advantages, and limits of each tool. This analytic review includes a simplified narrative of the commonly used basic and advanced respiratory monitors along with their limits and future prospective.

show abstract

“…S p O 2 -Zielwerte am unteren Ende des in der klinischen Versorgung verwendeten Bereichs (88–92 %) minimieren diese Risiken, können aber ein erhöhtes Risiko für die Entwicklung einer Hypoxämie und Gewebehypoxie bedeuten. Ein mittlerer S p O 2 -Zielwert (92–96 %) kann sowohl die Risiken einer Hyperoxie als auch einer Hypoxie verringern oder umgekehrt die Patienten intermittierend beiden Risiken aussetzen [ 7 ].…”

Section: Introductionunclassified

“…S p O 2 und p a O 2 haben jeweils Vor- und Nachteile als Zielgrößen bei kritischen Erkrankungen, einschließlich der Tatsache, dass die Genauigkeit der Pulsoxymetrie durch die Hautpigmentierung beeinträchtigt werden kann [ 8 ]. Die Ergebnisse dieser Studie, in der SpO 2 -Zielgrößen verwendet wurden, waren ähnlich wie die Ergebnisse früherer Studien, in denen p a O 2 -Zielgrößen verwendet wurden [ 7 ].…”

Section: Introductionunclassified