Dylla Layne, Anderson Erin L, Douin David J, Jackson Conner L, Rice John D, Schauer Steven G, Neumann Robert T, Bebarta Vikhyat S, Wright Franklin L, Ginde Adit A
From the Department of Emergency Medicine (L.D., E.L.A., R.T.N., C.V.S.B., A.A.G.), University of Colorado School of Medicine; Department of Anesthesiology (D.J.D.), University of Colorado School of Medicine; Department of Biostatistics and Informatics (C.L.J., J.D.R.), Colorado School of Public Health, Aurora, Colorado; US Army Institute of Surgical Research (S.G.S.), Houston; US Air Force 59th Medical Wing (S.G.S., C.V.S.B.), Office of the Chief Scientist, Lackland; Department of Emergency Medicine (S.G.S.), Brooke Army Medical Center, San Antonio, Texas; and Department of Surgery (F.L.W.) and Center for COMBAT Research, Department of Emergency Medicine (C.V.S.B., A.A.G.), University of Colorado School of Medicine, Aurora, Colorado.
J Trauma Acute Care Surg. 2021 Aug 1;91(2S Suppl 2):S169-S175. doi: 10.1097/TA.0000000000003177.
Avoidance of hypoxia and hyperoxia may reduce morbidity and mortality in critically ill civilian and military trauma patients. The objective of this study was to determine if a multimodal quality improvement intervention increases adherence to a consensus-based, targeted normoxia strategy. We hypothesized that this intervention would safely improve compliance with targeted normoxia.
This is a pre/postquasiexperimental pilot study to improve adherence to normoxia, defined as a pulse oximetry (SpO2) of 90% to 96% or an arterial partial pressure oxygen (PaO2) of 60 to 100 mm Hg. We used a multimodal informatics and educational intervention guiding clinicians to safely titrate supplemental oxygen to normoxia based on SpO2 monitoring in critically ill trauma patients admitted to the surgical-trauma or neurosurgical intensive care unit within 24 hours of emergency department arrival. The primary outcome was effectiveness in delivering targeted normoxia (i.e., an increase in the probability of being in the targeted normoxia range and/or a reduction in the probability of being on a higher fraction-inspired oxygen concentration [FiO2]).
Analysis included 371 preintervention subjects and 201 postintervention subjects. Preintervention and postintervention subjects were of similar age, race/ethnicity, and sex and had similar comorbidities and Acute Physiologic and Chronic Health Evaluation II scores. Overall, the adjusted probability of being hyperoxic while on supplemental oxygen was reduced during the postintervention period (adjusted odds ratio, 0.74; 95% confidence interval, 0.57-0.97). There was a higher probability of being on room air (FiO2, 0.21) in the postintervention period (adjusted odds ratio, 1.38; 95% confidence interval, 0.83-2.30). In addition, there was a decreased amount of patient time spent on higher levels of FiO2 (FiO2, >40%) without a concomitant increase in hypoxia.
A multimodal intervention targeting normoxia in critically ill trauma patients increased normoxia and lowered the use of supplemental oxygen. A large clinical trial is needed to validate the impact of this protocol on patient-centered clinical outcomes.
Therapeutic/care management, level II.
避免缺氧和高氧可能降低重症 civilian 和 military 创伤患者的发病率和死亡率。本研究的目的是确定多模式质量改进干预措施是否能提高对基于共识的目标性常氧策略的依从性。我们假设这种干预措施将安全地提高对目标性常氧的依从性。
这是一项前后半实验性试点研究，旨在提高对常氧的依从性，常氧定义为脉搏血氧饱和度（SpO2）为90%至96%或动脉血氧分压（PaO2）为60至100 mmHg。我们使用多模式信息学和教育干预措施，指导临床医生根据在急诊科就诊后24小时内入住外科创伤或神经外科重症监护病房的重症创伤患者的SpO2监测，安全地将补充氧气滴定至常氧水平。主要结局是实现目标性常氧的有效性（即处于目标性常氧范围内的概率增加和/或接受更高吸氧浓度[FiO2]的概率降低）。
分析纳入了371名干预前受试者和201名干预后受试者。干预前和干预后受试者的年龄、种族/民族和性别相似，合并症和急性生理与慢性健康状况评估II评分也相似。总体而言，干预后期补充氧气时处于高氧状态的校正概率降低（校正比值比，0.74；95%置信区间，0.57 - 0.97）。干预后期处于室内空气（FiO2，0.21）状态的概率更高（校正比值比，1.38；95%置信区间，0.83 - 2.30）。此外，患者在较高FiO2水平（FiO2，>40%）下的时间减少，且未伴随缺氧情况增加。
针对重症创伤患者常氧的多模式干预措施提高了常氧水平并降低了补充氧气的使用。需要进行大规模临床试验来验证该方案对以患者为中心的临床结局的影响。
治疗/护理管理，二级。
