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Research ArticleOriginal Research

Electronic Medical Record-Based Pager Notification Reduces Excess Oxygen Exposure in Mechanically Ventilated Subjects

Sonal R Pannu, Steven Holets, Man Li, Alberto Marquez, Rahul Kashyap, Guy Brock and Ognjen Gajic
Respiratory Care March 2021, 66 (3) 434-441; DOI: https://doi.org/10.4187/respcare.07573
Sonal R Pannu
Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, The Ohio State University, Columbus, Ohio.
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  • For correspondence: [email protected]
Steven Holets
Mayo Clinic, Department of Respiratory Care, Rochester, Minnesota.
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Man Li
Mayo Clinic, Department of Information Technology, Rochester, Minnesota.
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Alberto Marquez
Mayo Clinic, Department of Respiratory Care, Rochester, Minnesota.
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Rahul Kashyap
Mayo Clinic, Department of Anesthesiology, Division of Critical Care Medicine, Rochester, Minnesota.
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Guy Brock
Center for Biostatistics and Bioinformatics, The Ohio State University, Columbus, Ohio.
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Ognjen Gajic
Department of Pulmonary and Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
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Abstract

BACKGROUND: Liberal oxygenation during mechanical ventilation is harmful in critically ill patients and in certain subsets of patients, including those with stroke, acute myocardial infarction, and cardiac arrest. Surveillance through electronic medical records improves safety of mechanical ventilation in the ICU. To date, this practice has not been used for oxygen titration (Embedded Image) in adults. We hypothesize that a surveillance system based on the electronic medical record to alert respiratory therapists to titrate Embedded Image is feasible, safe, and efficacious.

METHODS: In this pilot study, mechanically ventilated subjects were randomized to respiratory therapist-driven Embedded Image titration after an electronic alert versus standard of care (ie, titration based on physician order). An automated surveillance system utilizing a hyperoxemia-detection algorithm generated an electronic alert to a respiratory therapist’s pager. Hyperoxemia was defined as Embedded Image > 0.5 and Embedded Image > 95% for > 30 min. No other aspects of treatment were changed. We assessed feasibility, safety, and preliminary efficacy. Primary outcome was duration of hyperoxemia during mechanical ventilation. An unsafe outcome was identified as hypoxemia (Embedded Image < 88%) within 1 h after titration per alert. Feasibility was assessed by a survey of respiratory therapists.

RESULTS: Of 226 randomized subjects, 31 were excluded (eg, programming errors of the electronic alerts, no consent, physician discretion). We included 195 subjects, of whom 86 were in the intervention arm. Alert accuracy was 78%, and respiratory therapists responded to 64% of the alerts. During mechanical ventilation, exposure to hyperoxemia significantly decreased in the intervention group (median 13.5 h [interquartile range 6.2–29.4] vs 18.8 h [interquartile range 9.6–37.4]). No episodes of significant hypoxemia were registered. Most respiratory therapists agreed that the alert was helpful in reducing excessive oxygen exposure.

CONCLUSIONS: Use of an electronic surveillance system to titrate Embedded Image was safe and feasible and showed preliminary efficacy in reducing hyperoxemia. Our study serves to justify larger randomized controlled trials for Embedded Image titration.

  • oxygen
  • hyperoxia
  • mechanical ventilation
  • electronic medical records
  • electronic alerts

Footnotes

  • Correspondence: Sonal R Pannu MD MSc, Davis Heart and Lung Institute, 473, west 12 th avenue, suite 201, Columbus, Ohio 43210. E-mail: sonal.pannu{at}osumc.edu
  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (3)
Respiratory Care
Vol. 66, Issue 3
1 Mar 2021
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Electronic Medical Record-Based Pager Notification Reduces Excess Oxygen Exposure in Mechanically Ventilated Subjects
Sonal R Pannu, Steven Holets, Man Li, Alberto Marquez, Rahul Kashyap, Guy Brock, Ognjen Gajic
Respiratory Care Mar 2021, 66 (3) 434-441; DOI: 10.4187/respcare.07573

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Electronic Medical Record-Based Pager Notification Reduces Excess Oxygen Exposure in Mechanically Ventilated Subjects
Sonal R Pannu, Steven Holets, Man Li, Alberto Marquez, Rahul Kashyap, Guy Brock, Ognjen Gajic
Respiratory Care Mar 2021, 66 (3) 434-441; DOI: 10.4187/respcare.07573
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Keywords

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