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Open Access 01-12-2014 | Research

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

Authors: Hendrik JF Helmerhorst, Marcus J Schultz, Peter HJ van der Voort, Robert J Bosman, Nicole P Juffermans, Evert de Jonge, David J van Westerloo

Published in: Annals of Intensive Care | Issue 1/2014

Abstract

Background

High 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.

Methods

In 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.

Results

In 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.

Conclusions

Most 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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Title: Self-reported attitudes versus actual practice of oxygen therapy by ICU physicians and nurses
Authors: Hendrik JF Helmerhorst
Marcus J Schultz
Peter HJ van der Voort
Robert J Bosman
Nicole P Juffermans
Evert de Jonge
David J van Westerloo
Publication date: 01-12-2014
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2014
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-014-0023-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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