Intensive Care Clinicians’ Attitudes and Self-Reported Practice of Conservative Oxygen Therapy

Abstract

Background: Conservative oxygen therapy (COT) targets a SpO2 of 90 - 92% using the lowest possible FiO2 for mechanically ventilated (MV) adult patients. Conservative oxygen therapy aims to maintain adequate oxygenation while avoiding the harmful effects of hyperoxaemia. However, a lower SpO2 target during MV is recognised as challenging in current clinical norms. Objectives: We sought to describe intensive care clinicians’ opinion and self-reported practice of conservative oxygen therapy. Methods: The research tool was a multi-choice questionnaire of intensive care clinicians working at 10 affiliated metropolitan tertiary hospitals from January-April, 2014. Results: Four hundred and twelve (84%) staff members responded to the survey. Of these, 91% (375) were intensive care nurses and 9% (37) were medical doctors. A majority of respondents (86%, 356/412) considered oxygen-related lung injury as “Yes, a major concern”. Most respondents, 85% (351/412), felt COT was easy to perform and a few respondents, 6% (23/412), considered performing COT to be stressful. More than 90% of the respondents reported not performing more arterial blood gases to monitor PaO2 during COT and essentially all (98%) indicated a desire to perform COT. Free text comments indicated COT as a challenge to current practice and expressed a strong desire to avoid inadvertent hypoxaemia. Conclusions: Intensive care clinicians varied in their opinion and self-reported practice of conservative oxygen therapy and were genuinely concerned about unintended physiological consequences related to targeting low SpO2 values. We recommend conservative oxygen therapy to be implemented cautiously in conjunction with further evaluation of its impact on outcomes for patients and the perceptions of clinicians.