Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Wong SW, Kwok PY, Lai CKP, Chan MH, Yu KY, Ngo OL, Chan WK
Affiliation :
Adult Intensive Care Unit, Queen Mary Hospital
Introduction :
Oxygen therapy is commonly prescribed to acutely ill patients. ICU patients are often managed with excess oxygen and hyperoxaemia as a result of efforts to prevent or reverse hypoxaemia. Conservative oxygen strategy which target a lower oxygen saturation (SpO2) target has been promulgated with evidence-based research findings. A protocol-driven oxygen titration was introduced for patients receiving invasive mechanical ventilation in an adult intensive care unit (AICU) to enhance patient safety.
Objectives :
1. To enahnce nurses' awareness of potential harm of hyperoxaemia and promulgate the use of evidence-based practice of conservative oxygen therapy. 2. To enhance patient safety with invasive mechanical ventilation in AICU and prevent hyperoaemia of patients.
Methodology :
All patients receiving mechanical ventilation were underwent oxygen titration unless contraindicated. Fraction of inspired oxygen (FiO2) was titrated as per protocol. Oxygen titration were performed based on physiological parameter of SpO2. The FiO2 was titrated down until target FiO2 was reached (FiO2 0.21). Episodes of desaturation were managed with up-titration of FiO2 as per protocol to ensure patient safety. Primary outcomes were mean partial pressure of oxygen (PaO2), mean SpO2 and mean FiO2 of ventilated patients who underwent oxygen titration. Nurses' compliance to the protocol were monitored with enhanced measures implemented.
Result & Outcome :
The oxygen titration was commenced since Sep 2021. A total 298, 356 and 103 patients who receiving invasive mechanical ventilation were underwent oxygen titration in 21/22,22/23 and 23/24(Sep to Nov) respectively. The means PaO2, mean SpO2 and mean FiO2 were 15.01kPa+/-8.61kPa, 96.53%+/-3.35%, 39.56%+/-19.71% in 21/22; 15.0kPa+/-8.97kPa, 96.48%+/-3.27%, 39.44%+/-20.17% in 22/23 and 15.25kPa+/-8.79%, 97.22%+/-2.67%, 39.68%+/-19.92% in 23/24(Sep to Nov) with p<0.05 respectively. A total 1,095, 1,130 and 276 episodes of oxygen titration were performed in 21/22, 22/23 and 23/24(Sep to Nov) respectively. Only 11.51%, 8.5% and 6.16% of patients experienced transient desaturation during oxygen titration and required titrated up the FiO2. No patients were suffered from severe desaturation and other respiratory complications during oxygen titration. The mean compliance of nurses compliance were 74.31%, 80.18% and 93.46% in 21/22, 22/23 and 23/24(Sep to Nov) respectively (p<0.034).
In conclusion, evidenced-based protocol-driven oxygen titration was successful implemented in AICU QMH and was a sustainable clinical practice. Nurses have improved their awareness on harm of hyperoxaemia and enhanced compliance to the protocol was shown. Indeed, it is a safe clinical practice to patients who receiving mechanical ventilation.
