Abstract
Objectives: A series of quality control (QC) targets (SpO2≠100%, PaCO2≮40 mmHg, Pmean≯10 cmH2O) was put forward and widely used in a single intensive care unit (ICU) setting. The aim of this study was to assess whether these QC targets could improve the outcomes of critically ill patients.Methods: The real-time clinical data of patients undergoing mechanical ventilation at ICU admission between May 2013 and May 2017 in the Department of Critical Care Medicine of Peking Union Medical College Hospital were collected and analyzed.Results: A total of 7,670 patients [mean age, 58 years; 3,943 (51.5%) male] were divided into the before QC (n = 3,936) and after QC (n = 3,734) groups. QC targets (SpO2, PaCO2, and Pmean) and respiratory parameters (FiO2%, PaO2, PEEP, tidal volume, and respiratory rate) within 72 h of ICU admission, primary outcomes (ICU mortality, 28-, 60-, and 90-day mortality) and secondary outcomes (discharge against medical advice, ICU admission days, mechanical ventilation times, and central venous pressure) were measured and compared between the before and after QC groups. The 72 h average of the Pmean, FiO2%, PaO2, and VT were significantly lower and PaCO2 was higher in the after QC than in the before QC group (P < 0.05). A lower 90-day mortality rate, less discharge against medical advice, fewer ICU admission days, and reduced mechanical ventilation times were found in the after QC group compared with the before QC group (P < 0.05). Interestingly, CVP was significantly lower in the after QC group than in the before QC group (P < 0.05).Conclusions: The QC targets (SpO2≠100%, PaCO2≮40 mmHg, Pmean≯10 cmH2O) contributed to avoiding high oxygen level hazards, protecting against lung injury, and improving circulatory function, which resulted in a better prognosis of critically ill patients.
Highlights
With the development of intensive care, clinicians are increasingly aware of the important role of some therapeutic concepts in critically ill patients, such as the assessment and implementation of fluid responsiveness, the use of lung protective ventilation, and the control and prevention of catheter-related infection
Breathing and circulation are the primary problems that need to be addressed in critically ill patients
Three parameters are used to control the effects of mechanical ventilation on breathing and circulation in critically ill patients: SpO2, PaCO2, and Pmean
Summary
With the development of intensive care, clinicians are increasingly aware of the important role of some therapeutic concepts in critically ill patients, such as the assessment and implementation of fluid responsiveness, the use of lung protective ventilation, and the control and prevention of catheter-related infection. Clinicians use these concepts to treat critically ill patients and achieve satisfactory results, accompanied by a decreased mortality rate. How these proven clinical practices can be used to control certain indicators to achieve the purpose of treatment drew our attention. Three parameters are used to control the effects of mechanical ventilation on breathing and circulation in critically ill patients: SpO2, PaCO2, and Pmean. Pmean plays a role in the impact of ventilation on circulatory functioning [9, 10] These three clinical targets are used to achieve the goal of treatment and reduce mortality. This study investigated the use of these three quality control (QC) targets before and after targets were implemented and showed that respiratory and circulatory QC targets affected the prognosis of critically ill patients
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