From the 2019 HVPAA National Conference
Mr. Owais Syed (UT Southwestern Medical Center), Dr. Neil Keshvani (University of Texas Southwestern), Dr. Bruno Alvarez (UT Southwestern Medical Center)
Hyperoxia is an issue of patient safety with risks for morbidity and mortality that is common in the setting of ICUs1. Supplemental oxygen, in excess, can be detrimental to patients. In 2008, the British Thoracic Society (BTS) published guidelines recommending that saturation goals when prescribing oxygen be conservative to limit hyperoxia. In the last 2015 BTS report, about 20% of all patients that receive any form of oxygen are persistently above O2 saturation goals in hospital emergency settings2. More recently, other major societies including the Global Initiative for Obstructive Lung Disease and the Thoracic Society of Australia and New Zealand have published guidelines focusing on the risk of mortality with hyperoxia in a wide array of patients afflicted with medical conditions including COPD and ARDS3.
This project aims to reduce by half the proportion of time mechanically ventilated patients are at risk for hyperoxia, here defined as SpO2> 96% while receiving supplemental oxygen within a year.
A retrospective review was used to establish baseline data for oxygen saturation range when MICU and SICU patients were mechanically ventilated and receiving supplemental oxygen over one month. All patients were age > 18. A total of 356 mechanically ventilated patients were identified. Data regarding age, diagnosis, time of intubation, time of extubation, hourly SpO2and FiO2were collected. This was a quality improvement project that did not require IRB approval prior to study.
Preliminary data of collected indicates that 82% of hourly SpO2measurements are with SpO2>96% while receiving supplemental oxygen, with an average FiO2of 36% ±8%. Interventions addressing establishing daily SpO2 goals and feedback on meeting those SpO2goals are discussed in this project.
Within this data pool, mechanically ventilated patients spend an important proportion of their time at an oxygen saturation higher than 96%. This would suggest that a performance gap is present and effective interventions should be considered to decrease the proportion of time mechanically ventilated patients spend with high oxygen saturation ranges with supplemental oxygen.
This work serves to both present a baseline status of a medical ICU in regards to hyperoxia and proposes the next steps of interventions based on a careful consideration of the setting involved. Given the momentum in research for establishing best practices, this paper can provide a system for other researchers to identify how large of a problem hyperoxia may be at their ICU and furthermore provide evidence on what interventions may work to solve a problem.