Do Respiratory Therapists Follow Oxygen Weaning Protocols in a Timely Manner?

Abstract

Background:

Supplemental O₂ is the treatment of choice for patients exhibiting documented hypoxemia. Evidence suggests however, that the over usage of O₂ may be associated with an increase in patient's medical cost, length of admission, and risk of O₂ toxicity. Departmental oxygen protocols have been created to minimize unnecessary exposure to O₂. Adherence to such protocols is rarely documented. The main goal of this study was to determine the overall recognition and response time it took for RTs in the ICU to wean the FIO₂ of patients as they met specific O₂ weaning protocol criteria.

Methods:

Retrospective chart review (medical, surgical-trauma, neurological, and transplant ICUs) conducted at a 622-bed university-affiliated hospital in San Antonio, TX. Inclusion criteria: > 18 y of age, current oxygen orders, ICU admission. Exclusion criteria: patients receiving ECMO, prn O₂ orders, respiratory arrest within the last 2 hours, and emergency intubation for CPR. Once the physician order was placed to initiate O₂ therapy, the following patient information was obtained from the EMR: demographics, O₂ modality, initial FIO₂, any changes to FIO₂ and time in hours before the first initial change in FIO₂.

Results:

Data was collected from 64 ICU patients (60% male) with a mean age of 56.0 years (± 18.3). On average, these patients spent 8.19 (± 8.4) d in the ICU. Most physician's orders were instructions for RT to maintain SpO₂> 92%. The mean number of hours on oxygen therapy was 7.27 (± 8.25) h. The mean FIO₂ that patients were initially placed on was 62.9% (± 28.3), and the most common documented oxygen weaning adjustment was a reduction of FIO₂ by 12.2 % (± 8.6). Mean SpO₂ before first change in FIO₂ was 96.6% (± 4.7) and time to first change in FIO₂ after meeting weaning criteria was 11.92 (± 18.9) h.

Conclusions:

The results of this study suggests that h weaning in ICU does not occur in a timely manner. RTs should be more proactive in weaning patients from oxygen therapy when parameters are met. These results could be used to revaluate and reinforce oxygen protocols and its adherence in order to minimize the time patients remain on oxygen.