Scripties UMCG - Rijksuniversiteit Groningen
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Titration of oxygen therapy in critically ill emergency department patients: a feasibility study

(2016) Dobbe, A. (Anique)

Introduction- Oxygen is one of the most widely used drugs and is applied across the wide range of specialities. Liberal use of oxygen to reassure oxygen delivery has become standard treatment in resuscitation: in the ambulance, the emergency department (ED) and the intensive care unit (ICU). Today, most health care professionals do not adjust the amount of oxygen given when patients reach a saturation of 100% or a PaO2 which exceeds the normal range, resulting in hyperoxia. Because oxygen is a vital element, toxicity is not immediately obvious, but there is increasing evidence for the toxic effects of hyperoxia. Because of these potential harmful effects of hyperoxia it seems justified to aim for normoxia when giving oxygen therapy. Objective- This study aims to evaluate whether it is feasible to aim for normoxia when giving oxygen therapy to critically ill patients at the ED. Material and methods- This study was a prospective cohort study and was performed at the ED of the University Medical Center Groningen (UMCG). A protocol was developed, aiming for normoxia: PaO2 9,5-13,5 kPa or a corresponding oxygen saturation 94-98%. Hyperoxia was defined as PaO2 > 13.5 kPa or SaO2 > 98%, and hypoxia as PaO2 < 9.5 kPa or SaO2 < 94%. During a 14 week period all patients >18 years admitted to the ED that were registered for cardiology, internal medicine, emergency medicine and pulmonology requiring oxygen therapy (according to the judgement of the ambulance nurse, ED nurse or ED physician) were included. Results- During the study period the protocol was followed and normoxia was obtained in 140 of the 162 study patients (86%). Patients in which the protocol was not successful were mostly severe COPD (GOLD III/IV) patients (P<0.001) and patients with a COPD exacerbation (P= 0.03). Furthermore we found that in patients arriving with prehospital oxygen the protocol was more often not followed. Among the patients who received prehospital oxygen, patients arriving with a NRM (non-rebreather mask) were more often hyperoxic (P <0.001) on arrival at the ED compared to patients arriving with oxygen via a nasal cannula. Conclusion- This study showed that it is feasible to titrate oxygen therapy to normoxia at the ED. These study results will be used for further research assessing the feasibility of normoxia and its potential beneficial effects compared to hyper- or hypoxia in ED patients.

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