Abstract
Aims & Objectives: Excessive oxygen can be detrimental to children requiring intensive care. However, reducing the oxygen saturation goal is not part of standard PIC culture. Oxygen is felt to be a therapy which does little harm and is beneficial for most pathologies, however evidence is mounting that excess oxygen is harmful. We investigated the set oxygen saturation limits on our patients and intervened to set them lower. Methods For one week, all monitored patients on the Critical Care unit requiring additional oxygen were analysed. Their monitor saturation limits were noted. Without informing the bedside team, the upper saturation limits were set to 98% (or 90% for a complex cardiac patient), unless the saturation limit was already below this. The following day, the same procedure was performed. Results Of 49 measurements, 38 had the upper limit set to “off” or 100%. 16/17 first measurements in an individual patient were at 100% of “off”. After setting the limit to the patient’s target, only 10/32 had an upper limit at target or less the next morning, 1/32 had an upper limit of 99%, and the 21/32 had been reset to “off” or 100%. Reasons given by the bedside nurses included alarm fatigue and a lack of medical directives.Conclusions In the complex Paediatric Intensive Care environment, there are significant behavioural drivers towards keeping the upper saturation limit off. Alarm fatigue is a real and dangerous problem, leading to substandard care if it is nor addressed. More education is necessary for teams to prioritise the correct oxygen saturations limits.
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