Intensive Care Clinicians’ Attitudes and Self-Reported Practice of Conservative Oxygen Therapy
Archives of Critical Care Medicine,
Vol. 1 No. 3 (2015),
27 October 2023
Abstract
Background: Conservative oxygen therapy (COT) targets a SpO2 of 90 - 92% using the lowest possible FiO2 for mechanically venti[1]lated (MV) adult patients. Conservative oxygen therapy aims to maintain adequate oxygenation while avoiding the harmful effects of hyperoxaemia. However, a lower SpO2 target during MV is recognised as challenging in current clinical norms.
Objectives: We sought to describe intensive care clinicians’ opinion and self-reported practice of conservative oxygen therapy.
Methods: The research tool was a multi-choice questionnaire of intensive care clinicians working at 10 affiliated metropolitan ter[1]tiary hospitals from January-April, 2014.
Results: Four hundred and twelve (84%) staffmembers responded to the survey. Of these, 91% (375) were intensive care nurses and 9% (37) were medical doctors. A majority of respondents (86%, 356/412) considered oxygen-related lung injury as “Yes, a major concern”. Most respondents, 85% (351/412), felt COT was easy to perform and a few respondents, 6% (23/412), considered performing COT to be stressful. More than 90% of the respondents reported not performing more arterial blood gases to monitor PaO2 during COT and essentially all (98%) indicated a desire to perform COT. Free text comments indicated COT as a challenge to current practice and expressed a strong desire to avoid inadvertent hypoxaemia.
Conclusions: Intensive care clinicians varied in their opinion and self-reported practice of conservative oxygen therapy and were genuinely concerned about unintended physiological consequences related to targeting low SpO2 values. We recommend conser[1]vative oxygen therapy to be implemented cautiously in conjunction with further evaluation of its impact on outcomes for patients and the perceptions of clinicians.
- Intensive Care Unit
- Hyperoxaemia
- Hypoxemia
- Conservative Oxygen Therapy
How to Cite
References
de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH,
et al. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care
unit patients. Crit Care. 2008;12(6):R156. doi: 10.1186/cc7150. [PubMed:
.
Panwar R, Capellier G, Schmutz N, Davies A, Cooper DJ, Bailey M,
et al. Current oxygenation practice in ventilated patients-an observational cohort study. Anaesth Intensive Care. 2013;41(4):505–14.
[PubMed: 23808511].
Fracica PJ, Knapp MJ, Piantadosi CA, Takeda K, Fulkerson WJ, Coleman RE, et al. Responses of baboons to prolonged hyperoxia: physiology and qualitative pathology. J Appl Physiol (1985). 1991;71(6):2352–62.
[PubMed: 1778933].
Lodato RF. Decreased O2 consumption and cardiac output during normobaric hyperoxia in conscious dogs. J Appl Physiol (1985).
;67(4):1551–9. [PubMed: 2793757].
Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter
K, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA.
;303(21):2165–71. doi: 10.1001/jama.2010.707. [PubMed: 20516417].
Rincon F, Kang J, Maltenfort M, Vibbert M, Urtecho J, Athar MK,
et al. Association between hyperoxia and mortality after stroke:
a multicenter cohort study. Crit Care Med. 2014;42(2):387–96. doi:
1097/CCM.0b013e3182a27732. [PubMed: 24164953].
Martin DS, Grocott MP. Oxygen therapy in critical illness: precise
control of arterial oxygenation and permissive hypoxemia. Crit Care
Med. 2013;41(2):423–32. doi: 10.1097/CCM.0b013e31826a44f6. [PubMed:
.
Suzuki S, Eastwood GM, Glassford NJ, Peck L, Young H, Garcia-Alvarez
M, et al. Conservative oxygen therapy in mechanically ventilated patients: a pilot before-and-after trial. Crit Care Med. 2014;42(6):1414–22.
doi: 10.1097/CCM.0000000000000219. [PubMed: 24561566].
Eastwood GM, Peck L, Young H, Suzuki S, Garcia M, Bellomo R.
Intensive care clinicians’ opinion of conservative oxygen therapy
(SpO(2) 90-92%) for mechanically ventilated patients. Aust Crit Care.
;27(3):120–5. doi: 10.1016/j.aucc.2013.11.004. [PubMed: 24369915].
Caputo A. Trends of psychology-related research on euthanasia: a qualitative software-based thematic analysis of journal abstracts. Psychol Health Med. 2015;20(7):858–69. doi:
1080/13548506.2014.993405. [PubMed: 25530297].
de Graaff AE, Dongelmans DA, Binnekade JM, de Jonge E. Clinicians’
response to hyperoxia in ventilated patients in a Dutch ICU depends on the level of FiO2. Intensive Care Med. 2011;37(1):46–51. doi:
1007/s00134-010-2025-z. [PubMed: 20878146].
Ayhan H, Iyigun E, Tastan S, Orhan ME, Ozturk E. Comparison of two
different oxygen delivery methods in the early postoperative period:
randomized trial. J Adv Nurs. 2009;65(6):1237–47. doi: 10.1111/j.1365-
2009.04984.x. [PubMed: 19374676].
Brokalaki H, Matziou V, Zyga S, Kapella M, Tsaras K, Brokalaki E, et al.
Omissions and errors during oxygen therapy of hospitalized patients
in a large city of Greece. Intensive Crit Care Nurs. 2004;20(6):352–7. doi:
1016/j.iccn.2004.07.003. [PubMed: 15567676].
Eastwood GM, O’Connell B, Considine J. Low-flow oxygen therapy in
intensive care: an observational study. Aust Crit Care. 2011;24(4):269–
doi: 10.1016/j.aucc.2011.04.005. [PubMed: 21570864].
Eastwood G, Bellomo R, Bailey M, Taori G, Pilcher D, Young P, et al.
Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Med. 2012;38(1):91–8. doi: 10.1007/s00134-011-2419-
[PubMed: 22127482]
- Abstract Viewed: 7 times
- PDF Downloaded: 0 times