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Research ArticleOriginal Research

Changes in Attitudes and Actual Practice of Oxygen Therapy in ICUs after Implementation of a Conservative Oxygenation Guideline

Chloe CA Grim, Hendrik JF Helmerhorst, Marcus J Schultz, Tineke Winters, Peter HJ van der Voort, David J van Westerloo and Evert de Jonge
Respiratory Care October 2020, 65 (10) 1502-1510; DOI: https://doi.org/10.4187/respcare.07527
Chloe CA Grim
Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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  • For correspondence: [email protected]
Hendrik JF Helmerhorst
Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
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Marcus J Schultz
Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
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Tineke Winters
Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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Peter HJ van der Voort
Department of Intensive Care Medicine, OLVG, Amsterdam, The Netherlands.
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David J van Westerloo
Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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Evert de Jonge
Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract

BACKGROUND: Little is known to what extent attitudes of ICU clinicians are influenced by new insights and recommendations to be more conservative with oxygen therapy. Our aim was to investigate whether implementation of a conservative oxygenation guideline structurally changed self-reported attitudes and actual clinical practice.

METHODS: After the implementation of a conservative oxygen therapy guideline in 3 teaching hospitals in the Netherlands, ICU clinicians were surveyed regarding their attitudes toward oxygen therapy. The survey results were compared with survey results taken before the introduction of the new guideline. Arterial blood gas analysis data and ventilator settings were retrieved from all patients admitted to the participating ICUs in the studied period, and changes after implementing the guideline were assessed.

RESULTS: In total, 180 ICU clinicians returned the survey. Compared to before implementation of a conservative oxygen guideline, more clinicians chose a preferred Embedded Image and an oxygen saturation measured from an arterial sample (Embedded Image) limit after implementation of the guideline. In general, clinicians reported a more conservative approach toward management of Embedded Image and less frequently increased the Embedded Image. In the period after the active implementation of the guideline, 5,840 subjects were admitted to the participating ICUs and 101,869 arterial blood gas analyses were retrieved. Actual practice changed with overall lower oxygenation levels (median Embedded Image 77.93 mm Hg, compared to 86.93 mm Hg before implementation) of arterial blood and a decrease of PEEP and Embedded Image.

CONCLUSIONS: Implementing a conservative oxygenation guideline was an effective method that changed self-reported attitudes and actual clinical practice and improved adherence to conservative oxygenation targets in a short period of time.

  • guideline
  • oxygen
  • intensive care units
  • critical care
  • mechanical ventilators
  • surveys and questionnaires

Footnotes

  • Correspondence: Chloe CA Grim MSc MD, Department of Intensive Care Medicine, Leiden University Medical Center Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail: c.c.a.grim{at}lumc.nl
  • Drs Grim, Helmerhorst, and de Jonge received grant support from the Netherlands Organization for Health Research and Development. The other authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (10)
Respiratory Care
Vol. 65, Issue 10
1 Oct 2020
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Changes in Attitudes and Actual Practice of Oxygen Therapy in ICUs after Implementation of a Conservative Oxygenation Guideline
Chloe CA Grim, Hendrik JF Helmerhorst, Marcus J Schultz, Tineke Winters, Peter HJ van der Voort, David J van Westerloo, Evert de Jonge
Respiratory Care Oct 2020, 65 (10) 1502-1510; DOI: 10.4187/respcare.07527

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Changes in Attitudes and Actual Practice of Oxygen Therapy in ICUs after Implementation of a Conservative Oxygenation Guideline
Chloe CA Grim, Hendrik JF Helmerhorst, Marcus J Schultz, Tineke Winters, Peter HJ van der Voort, David J van Westerloo, Evert de Jonge
Respiratory Care Oct 2020, 65 (10) 1502-1510; DOI: 10.4187/respcare.07527
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Keywords

  • guideline
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  • intensive care units
  • critical care
  • mechanical ventilators
  • surveys and questionnaires

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