Quality Improvement Report: Linking guideline to regular feedback to increase appropriate requests for clinical tests: blood gas analysis in intensive care

Merlani, Paolo; Garnerin, Philippe; Diby, Marc; Ferring, Martine; Ricou, Bara

doi:10.1136/bmj.323.7313.620

Cited by 104 publications

(88 citation statements)

References 21 publications

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“…However, the widespread adoption of continuous pulse oximetry, concerns about excessive blood draws and high costs, and reductions in placement of arterial lines have reduced the use of arterial blood gas sampling in critical illness. [6][7][8] Arterial blood gas sampling also may not be readily available in practice settings with limited resources. Th us, lack of arterial blood gas measurements in many patients may contribute to underdiagnosis of ARDS.…”

Section: [ 1 4 8 # 6 C H E S T D E C E M B E R 2 0 1 5 ]mentioning

confidence: 99%

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Cui

Janz

Shaver

et al. 2015

Chest

134

116

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Section: [ 1 4 8 # 6 C H E S T D E C E M B E R 2 0 1 5 ]mentioning

confidence: 99%

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Cui

Janz

Shaver

et al. 2015

Chest

134

116

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show abstract

“…Great personnel and financial resources are required to develop guidelines. Disappointingly, observational studies [1][2][3][4][5][6][7] and randomized controlled trials 8 conducted within the intensive care unit (ICU) have generally shown no clear benefit from the use of guidelines as measured by improvements in processes and outcomes of patient care. High quality professional society practice guidelines such as the recent guidelines for the prevention of ventilator associated pneumonia jointly developed by the Canadian Critical Care Society (CCCS) and the Canadian Critical Care Trials Group 9 may have had a different effect, but this has not been measured.…”

Section: Conclusion : De Nombreuses Institutions Canadiennes Dévelop-mentioning

confidence: 99%

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

Sinuff

Eva

Meade

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: To understand clinicians' perceptions regarding practice guidelines in Canadian intensive care units (ICUs) to inform guideline development and implementation strategies. Methods:We developed a self-administered survey instrument and assessed its clinical sensibility and reliability. The survey was mailed to ICU physicians and nurses in Canada to determine local ICU guideline development and use, and to compare physicians' and nurses' attitudes and preferences towards guidelines. Results:The survey was completed by 51.6% (565/1095) of potential respondents. Although less than half reported a formal guideline development committee in their ICU, 81.0% reported that guidelines were developed at their institutions. Of clinicians who used guidelines in the ICU, 70.2% of nurses and 42.6% of physicians reported using them frequently or always. Professional society guidelines (with or without local modification) were reportedly used in most ICUs, but physicians were more confident than nurses of their validity (P < 0.001). Physicians considered endorsement of guidelines by a colleague more relevant for enhancing guideline use than did nurses (P < 0.001). Nurses considered low risk of the guideline and whether the guideline is consistent with their practice (P < 0.001) to be more relevant to guideline uptake than did physicians (P < 0.001). Lack of agreement with recommendations was a more important barrier to use of guidelines for physicians than for nurses (P < 0.001).Conclusions: Many Canadian institutions locally develop guidelines, and many ICU physicians and nurses report using them.Planning implementation strategies according to clinician preferences may increase guideline use. The nature of the differences in attitudes towards guidelines between nurses and physicians, and their impact on clinician adherence to guidelines requires further exploration.

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“…[13] Apart from its wide spread use in paediatrics, it has also been used for adults to diagnose ALI and ARDS in critically ill patients with anaemia where avoiding excessive blood draws can serve as a boon to the patient. [14][15][16] SpO 2 /FiO 2 ratio may also be needful in other important clinical applications such as Lung Injury Score, Sequential Organ Failure Assessment, Simplified Acute Physiology Score II, or Multi Organ Dysfunction Score that utilise P/F ratios to quantify hypoxemia. [8,[17][18][19] …”

Section: Discussionmentioning

confidence: 99%

Can pulse oximetric saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio surrogate PaO2/ FiO2 ratio in diagnosing acute respiratory failure?

Mehta¹,

Shah²

2016

Int J of Biomed & Adv Res

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Introduction: The condition of acute respiratory failure is one of the most common as well as serious condition that is encountered in the ICU. Diagnosis and immediate management can increase the rate of survival among these patients. Aiming to attain this goal and to ensure that no invasive procedure is tried on the patient several studies have tried to substitute the use of PaO 2 /FiO 2 which is an invasive procedure and risky for patients who have severe blood loss or are anaemic by other reliable markers out of which SpO 2 /FiO 2 has shown some promise in paediatric age groups. Another disadvantage of using PaO 2 /FiO 2 is the time it takes to evaluate the condition and give us results that can help us diagnose the patient .This study explores the possibility of it being used for the adult age group. Materials and methods: A sample size of 50 patients was taken and a total of 101 observations from these patients were recorded. The observations from these patients included SpO 2 /FiO 2 , PaO 2 /FiO 2 , vitals (heart rate, respiratory rate, SBC, blood pressure), presence of crepitations, chest X ray infiltrates and the use of ventilator. A statistical analysis was then undertaken comparing SpO 2 /FiO 2 ratio and PaO 2 /FiO 2 ratio. This correlation was statistically analysed by plotting graphs and was checked whether they are significant or insignificant. Result: It was observed that SpO 2 /FiO 2 ratio correlates very well with PaO 2 /FiO 2 ratio (R = 0.375). A formula was also derived using the graph which could help us find value of SpO 2 /FiO 2 ratio using PaO 2 /FiO 2 ratio and vice versa. SpO 2 /FiO 2 =0.559(PaO 2 /FiO 2 )+157.9 Conclusion: From the above study we can conclude that PaO 2 /FiO 2 can be surrogated by the use of SpO 2 /FiO 2 ratio which is much more inexpensive, invasive and most of all saves the time required for doing ABG analysis in adult age group also.

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Quality Improvement Report: Linking guideline to regular feedback to increase appropriate requests for clinical tests: blood gas analysis in intensive care

Abstract: A multifaceted intervention can substantially decrease the number of requests for arterial blood gas analysis and increase their appropriateness without affecting patient safety.

Cited by 104 publications

References 21 publications

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

Can pulse oximetric saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio surrogate PaO2/ FiO2 ratio in diagnosing acute respiratory failure?

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