• Annals of intensive care · Jan 2014

    Self-reported attitudes versus actual practice of oxygen therapy by ICU physicians and nurses.

    • Hendrik Jf Helmerhorst, Marcus J Schultz, Peter Hj van der Voort, Robert J Bosman, Nicole P Juffermans, Evert de Jonge, and David J van Westerloo.
    • Department of Intensive Care Medicine, Leiden University Medical Center, Leiden 2300, RC, The Netherlands ; Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam 1105, AZ, The Netherlands.
    • Ann Intensive Care. 2014 Jan 1;4:23.

    BackgroundHigh inspiratory oxygen concentrations are frequently administered in ventilated patients in the intensive care unit (ICU) but may induce lung injury and systemic toxicity. We compared beliefs and actual clinical practice regarding oxygen therapy in critically ill patients.MethodsIn three large teaching hospitals in the Netherlands, ICU physicians and nurses were invited to complete a questionnaire about oxygen therapy. Furthermore, arterial blood gas (ABG) analysis data and ventilator settings were retrieved to assess actual oxygen practice in the same hospitals 1 year prior to the survey.ResultsIn total, 59% of the 215 respondents believed that oxygen-induced lung injury is a concern. The majority of physicians and nurses stated that minimal acceptable oxygen saturation and partial arterial oxygen pressure (PaO2) ranges were 85% to 95% and 7 to 10 kPa (52.5 to 75 mmHg), respectively. Analysis of 107,888 ABG results with concurrent ventilator settings, derived from 5,565 patient admissions, showed a median (interquartile range (IQR)) PaO2 of 11.7 kPa (9.9 to 14.3) [87.8 mmHg], median fractions of inspired oxygen (FiO2) of 0.4 (0.4 to 0.5), and median positive end-expiratory pressure (PEEP) of 5 (5 to 8) cm H2O. Of all PaO2 values, 73% were higher than the upper limit of the commonly self-reported acceptable range, and in 58% of these cases, neither FiO2 nor PEEP levels were lowered until the next ABG sample was taken.ConclusionsMost ICU clinicians acknowledge the potential adverse effects of prolonged exposure to hyperoxia and report a low tolerance for high oxygen levels. However, in actual clinical practice, a large proportion of their ICU patients was exposed to higher arterial oxygen levels than self-reported target ranges.

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