45 ‘O₂ SAFE’: goal directed oxygen therapy in surgical intensive care unit

Background This project underscored the significance of a cautious and patient-centred approach to oxygen (O₂) therapy in the Surgical Intensive Care Unit (SICU). We targeted higher saturations without clinical indication and prescription. Our aim was to improve optimal O₂ utilization in level 1 and 2 patients by targeting SpO₂ of 94 to 98% ^{1 2} with no or minimal oxygen supplement (≤ 2liters) from 18% to 60% from July to December 2023.

Methods An evidence-based algorithm for oxygen prescription^{1 3} was created, followed by staff training. Institute for Healthcare Improvement (IHI) methodology was followed. The processes were 1) physicians’ compliance to initiate prescription for oxygen therapy in Cerner upon admission and 2) nurses’ compliance to wean patients from supplemental oxygen to room air or nasal cannula ≤ 2liters/minute within 3 hours while ensuring their SpO₂ remained between 94% and 98%.

Results Patients managed effectively in SICU with minimal or no oxygen improved from 18% to over 80% (figure 1). The processes that contributed were improvement in oxygen prescription placement by physicians from 0% to over 60%, and the confidence gained by nurses and respiratory therapists to accept lesser and safer saturation improved from 20% to over 86% (figure 2). Other contributing factors were early initiation of spirometry and chest physiotherapy (improved from 0% to over 70%). Our intervention significantly reduced the consumption of oxygen from 42,270 litres/week to 4,770 litres/week.

Conclusion Oxygen is a lifeline for many patients but misusing it by targeting higher saturation ^{1 3} without prescription leads to detrimental effects. We aimed to strike a balance between providing adequate oxygen therapy and preventing potential risks associated with hyperoxia³. This intervention helped optimize patient outcomes, enhanced SICU quality of care and contributed to reducing the cost of oxygen utilization. This might have helped reduce SICU patients’ length of stay.

References

1. Girardis M, Busani S, Damiani E, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit. The oxygen-ICU randomized clinical trial, JAMA. 2016;316(15):1583–1589. doi:10.1001/jama.2016.11993

2. Siemieniuk RAC, Chu DK, Kim LHY, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. The British Medical Journal, Rapid Recommendations October 2018;363:k4169. Accessed 17 Dec. 2023. https://www.jstor.org/stable/26964485.

3. Singer M, Young PJ, Laffey JG, et al. Dangers of hyperoxia, Critical Care 2021;25(1):440. doi: 10.1186/s13054-021-03815-y

Ethical Approval/IRB Statement This is a Quality improvement project initiated with the approval of Hamad General Hospital Quality Department and included as one of the VIP projects in SICU.

Disclosures and Acknowledgments The team members have nothing to disclose.