title: Efficiency of goal-directed oxygen delivery in ICU patients.
abstract: BACKGROUND
  Current clinical practice guidelines promote a goal-directed approach for oxygen delivery with respect to SpO₂ objectives. We evaluated the efficiency of a strategy based on goal-directed O₂ delivery in the ICU.
  
  
  METHODS
  A group of 30 patients (Group 1) with a proven history of chronic obstructive pulmonary disease suffering from acute hypercarbic exacerbation was compared to 2 other groups of patients admitted for acute respiratory failure with no history of pulmonary disease: 30 patients requiring oxygen supply and/or non-invasive ventilation (Group 2) and 30 requiring invasive ventilation (Group 3). The delivery of oxygen was based on SpO₂ measurement: 88-94% for Group 1 and 90-96% for others. The time spent with an SpO₂ below, within and above the prescribed limits was collected.
  
  
  RESULTS
  The mean time spent within the prescribed range was for Groups 1, 2 and 3, respectively as follows: 61.9% [60.5-63.2], 63.7% [62.3-65] and 56.4% [55.3-57.6] (P < 0.001 for each group). A history of chronic obstructive pulmonary disease was not correlated with better results (P = 0.11), while invasive ventilation was related to the time spent out of the prescribed range (P < 0.001; OR 1.3 [1.22-1.28]) especially in hyperoxaemia (40.7% [39.6-41.8] P < 0.001). Efficiency seems unrelated to nursing workload or night team exhaustion (r = -0.09, P = 0.77).
  
  
  CONCLUSIONS
  Goal-directed oxygen delivery based on SpO₂ objectives in ICU patients ensures that in only approximately 64% of the time, SpO₂ stays within the prescribed range.
authors.affiliation: Intensive and Emergency Care Medicine Department, Clinical Research Unit, Melun Hospital, Melun, France. sebastien.jochmans@ch-melun.fr.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Jochmans
authors.forename: Ly-Van Phach
authors.initials: LV
authors.lastname: Vong
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rolin
authors.forename: Oumar
authors.initials: O
authors.lastname: Sy
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chelly
authors.forename: Olivier
authors.initials: O
authors.lastname: Ellrodt
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: Alphonsine
authors.forename: Jean
authors.initials: J
authors.lastname: Serbource-Goguel
authors.forename: Razach Idriss
authors.initials: RI
authors.lastname: Abdallah
authors.forename: Claire-Marie
authors.initials: CM
authors.lastname: Weyer
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
authors.forename: Christophe
authors.initials: C
authors.lastname: Vinsonneau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D005260:Female; D006040:Goals; D006801:Humans; D018496:Hyperoxia / Q000097:blood / Q000628:therapy; D000860:Hypoxia / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D063087:Noninvasive Ventilation; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D016526:Workload
chemical_list: D010100:Oxygen
keywords: goal-oriented therapy; hyperoxaemia; hypoxaemia; mechanical ventilation; nurse protocol; oxygen therapy; pulse oximetry