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

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 ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{\text{2}}}}$ and an oxygen saturation measured from an arterial sample ( ${\mathbf{\text{S}}}_{{\mathbf{\text{aO}}}_{\mathbf{2}}}$ ) limit after implementation of the guideline. In general, clinicians reported a more conservative approach toward management of ${\mathbf{\text{F}}}_{{\mathbf{\text{IO}}}_{\mathbf{2}}}$ and less frequently increased the ${\mathbf{\text{F}}}_{{\mathbf{\text{IO}}}_{\mathbf{2}}}$ . 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 ${\mathbf{\text{P}}}_{{\mathbf{\text{aO}}}_{\mathbf{2}}}$ 77.93 mm Hg, compared to 86.93 mm Hg before implementation) of arterial blood and a decrease of PEEP and ${\mathbf{\text{F}}}_{{\mathbf{\text{IO}}}_{\mathbf{2}}}$ .

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.