Oxygenation targets, monitoring in the critically ill: a point prevalence study of clinical practice in Australia and New Zealand.
BACKGROUND
Many critically ill patients require supplemental oxygen. However, the optimal oxygen saturation measured by pulse oximetry (SpO₂) in intensive care unit patients is unknown.


OBJECTIVE
To evaluate clinical practice in Australia and New Zealand ICUs in relation to SpO₂monitoring, prescription of SpO₂targets by doctors, and upper and lower limits of tolerance of high and low SpO₂levels by ICU bedside nurses.


METHODS
Cross-sectional, observational study conducted on 2 days in 2013 involving adult patients in Australia and New Zealand ICUs.


RESULTS
Data from 350 adult ICU patients were included. SpO₂alarms were less likely to be disabled in patients who were invasively ventilated than in patients not receiving supplemental oxygen (4.8% v 15.1%; P = 0.02). In mechanically ventilated patients and non-ventilated patients receiving supplemental oxygen, the lower prescribed SpO₂limit and the ICU bedside nurses' stated limits for action for low SpO₂levels were 92% (interquartile range, 90%-94%). Upper SpO₂limits were less frequently prescribed than lower SpO₂limits (4.9% [95% CI, 3.0%- 7.7%] v 36.6% [95% CI, 31.7%-41.7%]); P < 0.01) and the observed SpO₂exceeded the prescribed upper limit on 10/17 occasions (59%) when an upper limit was prescribed.


CONCLUSIONS
Our findings suggest a relatively low level of vigilance in relation to prevention of high SpO₂compared with low SpO₂for adult patients in Australian and New Zealand ICUs.
Medical Research Institute of New Zealand, Wellington, New Zealand. Paul.Young@ccdhb.org.nz.
Paul J
PJ
Young
Medical Research Institute of New Zealand, Wellington, New Zealand.
Richard W
RW
Beasley
CHRU Besançon, Université de Franche-Comté, Besançon, France.
Gilles
G
Capellier
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Glenn M
GM
Eastwood
The George Institute for International Health, Sydney, NSW, Australia.
Steve A R
SA
Webb
D000328:Adult; D000368:Aged; D001315:Australia; D003422:Critical Care; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D018496:Hyperoxia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010092:Oximetry; D010102:Oxygen Inhalation Therapy; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial