Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients

Jonge, Evert de; Peelen, Linda M.; Keijzers, Peter J M; Joore, Hans C. A.; Lange, Dylan W. de; Voort, Peter Hj van der; Bosman, R. J.; Waal, Ruud Al de; Wesselink, R. M. J.; Keizer, Nicolette F. de

doi:10.1186/cc7150

Cited by 343 publications

(301 citation statements)

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“…To maintain adequate P aO 2 , F IO 2 is usually set higher than O 2 in ambient air. 1 Although several studies have provided epidemiological data for O 2 administration in critically ill subjects, [1][2][3][4][5] the evidence is insufficient for deciding the best target values for P aO 2 and optimal titration of F IO 2 during mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

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Hyperoxemia in Mechanically Ventilated, Critically Ill Subjects: Incidence and Related Factors

et al. 2014

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BACKGROUND: Excessive supplemental oxygen causes injurious hyperoxemia. Before establishing the best P aO 2 targets for mechanically ventilated patients, it is important to understand the incidence of hyperoxemia and related factors. We investigated oxygenation in mechanically ventilated subjects in our ICU and evaluated factors related to hyperoxemia (P aO 2 > 120 mm Hg) at 48 h after initiation of mechanical ventilation. METHODS: We retrospectively reviewed the medical records of patients admitted to our ICU from January 2010 to May 2013. Inclusion criteria were 15 y of age or older and administration of mechanical ventilation for > 48 h. Patients at risk of imminent death on admission or who had received noninvasive ventilation were excluded. We collected subject demographics, reasons for mechanical ventilation, and during mechanical ventilation, we collected arterial blood gas data and ventilator settings on the first day of intubation (T1), 48 h after initiation of mechanical ventilation (T2), and on the day of extubation (T3). Multivariable logistic regression analysis was performed to clarify independent variables related to hyperoxemia at T2. RESULTS: For the study period, data for 328 subjects were analyzed. , and decompensated heart failure (odds ratio 1.9, 95% CI 1.1 to 3.5). CONCLUSIONS: During mechanical ventilation of critically ill subjects, P aO 2 increased, and F IO 2 decreased. One in 4 subjects were hyperoxemic at T2, and hyperoxemia persisted until T3.

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Section: Introductionmentioning

confidence: 99%

“…3 Adverse outcomes of hyperoxemia were identified in patients after cardiac arrest 6 and acute myocardial infarction 7 and in extremely premature infants. 8 Animal studies have demonstrated that high F IO 2 increases free radicals and causes an influx of inflammatory cells in the lung, 9 pulmonary permeability, and endothelial cell injury.…”

Section: Introductionmentioning

confidence: 99%

Hyperoxemia in Mechanically Ventilated, Critically Ill Subjects: Incidence and Related Factors

et al. 2014

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“…[18][19][20] For this reason, it will be necessary to adjust the track and trigger scoring systems to ensure that staff are alerted to the risks of hyperoxaemia as well as of hypoxaemia. Systems are being trialled in which patients are allocated three EWS points if the SpO 2 is above or below the predefined target It will be important to identify the most effective method of managing the clinical response to elevated EWS, but the precise clinical usefulness of METs and RRTs have yet to be proven.…”

Section: Future Directionmentioning

confidence: 99%

Acute monitoring of patients with chronic respiratory disease during hospital admission

2012

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“…Oxygen therapy may be a life-saving intervention and is an intervention applied essentially to all intensive care unit (ICU) patients (1). Intensive care clinicians play a vital role in the administration and management of oxygen therapy for patients admitted to the intensive care unit (ICU) (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…Intensive care clinicians play a vital role in the administration and management of oxygen therapy for patients admitted to the intensive care unit (ICU) (1,2). Evidence from animal (3,4) and human studies (5, 6) has continued to identify the injurious effects of prolonged hyperoxaemia.…”

Section: Introductionmentioning

confidence: 99%

Intensive Care Clinicians’ Attitudes and Self-Reported Practice of Conservative Oxygen Therapy

et al. 2015

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Background: Conservative oxygen therapy (COT) targets a SpO2 of 90 -92% using the lowest possible FiO2 for mechanically ventilated (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 tertiary hospitals from January-April, 2014. Results: Four hundred and twelve (84%) staff members 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 conservative oxygen therapy to be implemented cautiously in conjunction with further evaluation of its impact on outcomes for patients and the perceptions of clinicians.

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Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients

Abstract: Introduction The aim of this study was to investigate whether inhospital mortality was associated with the administered fraction of oxygen in inspired air (FiO 2 ) and achieved arterial partial pressure of oxygen (PaO 2 ).

Cited by 343 publications

References 38 publications

Hyperoxemia in Mechanically Ventilated, Critically Ill Subjects: Incidence and Related Factors

Hyperoxemia in Mechanically Ventilated, Critically Ill Subjects: Incidence and Related Factors

Acute monitoring of patients with chronic respiratory disease during hospital admission

Intensive Care Clinicians’ Attitudes and Self-Reported Practice of Conservative Oxygen Therapy

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