Acute Oxygen Therapy Research Articles

Knowledge of Oxygen Therapy among Nurses in a Tertiary Hospital in Kenya: Implications for Patient Care and Training Needs

Aim: The aim of this study was to evaluate the knowledge of oxygen therapy among nurses working in pediatric and medical units at a referral hospital in limited resource setting. Design: A Cross-Sectional Survey. Methods: A total of 213 nurses participated after completing an acute oxygen therapy questionnaire that assessed their knowledge of oxygen therapy. The data were analyzed using descriptive statistics and explored the association between variables with chi-square or t-test at P < 0.05. Results: The mean age of participating nurses was 37 years, and over 50% were female. On average, participants had not undergone any refresher course on oxygen therapy in the preceding three years. Oxygen therapy knowledge was found to be higher in male nurses (p = 0.008), those who were aware of the WHO guidelines for oxygen therapy (p = 0.006), and those in senior positions (0.028). Paediatric nurses scored higher in the ‘Recognizing Hypoxemia’ domain than nurses in the medical department (p = 0.003). The domain with the lowest number of correct items identified by participants was ‘Clinical Practices’ (3.23 ± 1.04). Being older (r2 = -0.135) and having worked in the facility for longer (r2 = -0.156) correlated with low knowledge of correct oxygen therapy documentation. Conclusion This study identified gaps in knowledge of oxygen therapy among nurses at a referral hospital in Kenya and emphasized the importance of re-training nurses involved in oxygen therapy administration.

Doctors' and Nurses' Knowledge and Perceived Barriers Regarding Acute Oxygen Therapy in a Tertiary Care Hospital in Nigeria.

Oxygen may cause serious consequences when administered wrongly. This study aimed to assess doctors' and nurses' knowledge of acute oxygen therapy and perceived delivery barriers. We conducted a cross sectional study among 202 healthcare providers (134 doctors and 68 nurses) in a Nigerian hospital. The validated Acute Oxygen Therapy Questionnaire (AOTQ), which consisted of 21 knowledge assessment questions, was self administered by participants. Provider's knowledge was classified as good if the score was≥80% and poor if < 60%. Overall, 26.7% (37.3% doctors and 5.9% nurses) had good knowledge of acute oxygen therapy (AOT), 35.9% were aware, and 19.3% used the AOT guidelines. The commonest source of knowledge on oxygen therapy was medical /nursing school (75.2%). The participants' mean knowledge score was 14.75 ± 2.83(possible score of 0-21). Doctors in postgraduate (PG) training obtained the highest score (15.96±2.48) among the participants (F=12.45, df=4, p<0.001). Most doctors (62%) and 23.5% of nurses considered oxygen as a drug. More doctors (52.2%) than nurses (14.7%) believed that a doctor's order was mandatory before oxygen administration, contrary to guidelines recommendations. Most nurses did not know that breathlessness does not always signify hypoxemia and that asymptomatic anemia was not an indication for oxygen. Concerning oxygen prescription, 39.7% of nurses and 64.2% of doctors knew that it should be prescribed to achieve a target saturation range rather than a fixed dose. In acute oxygen delivery in COPD, doctors and nurses exhibited poor knowledge of the appropriate device and flow rate. The reported barriers to oxygen delivery were: a shortage of oxygen supply, inadequate delivery devices, power outages and out of pocket costs. A significant proportion of doctors and nurses had poor knowledge of acute oxygen therapy, poor awareness and infrequently used AOT guidelines, and reported pertinent delivery barriers that warrant educational and administrative interventions.

Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: 'Swimming between the flags'.

Oxygen is a life‐saving therapy but, when given inappropriately, may also be hazardous. Therefore, in the acute medical setting, oxygen should only be given as treatment for hypoxaemia and requires appropriate prescription, monitoring and review. This update to the Thoracic Society of Australia and New Zealand (TSANZ) guidance on acute oxygen therapy is a brief and practical resource for all healthcare workers involved with administering oxygen therapy to adults in the acute medical setting. It does not apply to intubated or paediatric patients. Recommendations are made in the following six clinical areas: assessment of hypoxaemia (including use of arterial blood gases); prescription of oxygen; peripheral oxygen saturation targets; delivery, including non‐invasive ventilation and humidified high‐flow nasal cannulae; the significance of high oxygen requirements; and acute hypercapnic respiratory failure. There are three sections which provide (1) a brief summary, (2) recommendations in detail with practice points and (3) a detailed explanation of the reasoning and evidence behind the recommendations. It is anticipated that these recommendations will be disseminated widely in structured programmes across Australia and New Zealand.

Acute Oxygen Therapy: An Audit of Prescribing and Delivery Practices in the Medical Wards at Dr. George Mukhari Academic Hospital, Pretoria, Gauteng

Background: Oxygen is a commonly used drug in modern medical care. It has biochemical actions, safe dosage ranges, adverse physiologic effects and can be toxic at high doses and prolonged use. As a drug, it needs a formal prescription prior to administration. The prescription needs to meet certain basic minimums for appropriateness and safety. Objectives: The aim of the study was to assess the standards of prescriptions for oxygen therapy amongst admitted medical patients at the Dr. George Mukhari Academic Hospital. Materials and Methods: It was a cross-sectional study of 159 acutely ill medical admissions who received supplemental oxygen. The medication charts of patients on oxygen were audited; with regards to the availability and/or adequacy of the prescription for oxygen. Results: Of the one hundred and fifty nine patients on oxygen only 43 (27%) had an actual prescription for oxygen written. The target oxygen saturation was specified in 19 (44%) cases. The device for oxygen delivery was specified in 21 (49%) patients and just over half of the patients (56%) had flow rates indicated on their charts. Conclusion: The practice of oxygen administration in our medical wards was sub-optimal. The audit highlights the need for education and training in acute oxygen therapy.

A KNOWLEDGE, ATTITUDE AND PRACTICE STUDY OF PRESCRIBING OXYGEN AMONGST INTERNS IN A TERTIARY CARE HOSPITAL

Background: Oxygen is one of the most frequently prescribed health-care interventions and resuscitative methods to patients visiting the emergency or while admitted to the hospital. The ongoing COVID pandemic has emphasized the importance of efficient and optimal oxygen utilization. The interns in a teaching hospital are often the first point of contact for patients. Materials and Methods: A cross-sectional questionnaire-based study was done amongst 100 interns posted in areas where oxygen is routinely prescribed. For this study, a questionnaire was devised by the investigators to assess the Knowledge, Attitude and Practice of prescribing oxygen therapy. The questionnaire also included the validated acute oxygen therapy questionnaire (AOTQ). Results: Knowledge of participants ascertained using the validated AOTQ questionnaire revealed a score of 16.59 ± 1.94 out of a maximum of 23 points suggesting that majority of participants possessed mediocre knowledge. The author’s questionnaire showed significant gaps in knowledge and attitude; participants were relatively ill-informed about the interfaces used, the indications, and monitoring required while administering oxygen. Conclusion: There is an admissible gap in knowledge, attitude and practices pertaining to oxygen therapy as compared to the ideal. The development of standard training guidelines and suitable methodologies is absolutely crucial so that optimal therapy can be provided by fresh medical graduates without compromising patient care.

Assessment of Nurse's Knowledge and Practice Regarding Oxygen Therapy at Teaching Hospitals in Al- Nasiriya City\ Iraq

Background: Oxygen therapy is considered the most common drug in the treatment of many life-threatening diseases such as respiratory failure, chronic obstructive pulmonary disease, and others. Particularly now, with the spread of the Coronavirus outbreak, it has become the main drug to save the patients' lives and care for them. As a result, the nurse should have more kills and experience to performing this procedure in the aim to maintain the patient's life safe and avoid complications associated with incorrect oxygen administration technique. Aims of the study: To assess nurses' knowledge and practice regarding oxygen therapy in (critical care units), (emergency units), (oncology units) at Al-Haboby Teaching Hospital and Al-Hussein Teaching Hospital in Al-Nasiriya City. Methodology: A descriptive research design was adopted to conduct this study during the period from (14 November 2020 to 20 March 2021).The study was purposive (non-probability) sample of (60) nurses who are working in (critical care units), (emergency units), (oncology units) at Al- Haboby Teaching Hospital and Al-Hussein Teaching Hospital in Al- Nasiriya City. A self-administered questionnaire was constructed by the researcher for the purpose of data collection regarding nurse's knowledge and practice about oxygen therapy. It consisted of three parts: Part I: Part one contains (12) item including demographic data, Part II: This part deals with nurse’s knowledge and consists of five domains, and Part III: Observational Checklist about nurse’s practice during oxygen administration, it contains (26) items. Study began after requested permission to use the tool. The validity of the study instrument (questionnaire) are determined by experts, who have more than five years’ experience in their fields to determine the clarity and adequacy of the questionnaire to achieve the study objectives. They are (8) faculty members from College of Nursing / University of Baghdad, (1) faculty members from College of Nursing /University of Karbala, (1) faculty member from College of Nursing /University of Thi-Qar, (2) specialized physician in Thoracic diseases and (2) Board anesthesia &intensive care. The questionnaire was finalized after the pilot study was used to test the instrument, the results of the reliability for the questionnaire were the reliability of knowledge was r=0.832 and the reliability of practice by (intra observation) was r=0.821 it considered within the acceptable range and the questionnaires had an adequate level of internal consistency and equivalence measurability. The data were analyzed by applying descriptive and inferential data by application of statistical package for social science program (SPSS) version 23.0. Results: show that, the study sample was presented a low level of knowledge at all five domains related (general knowledge of oxygen therapy and recognizing hypoxemia, indications for acute oxygen therapy, oxygen prescription, and oxygen delivery practices). While in relation to practice, the sample presented low level of practice at both domains (before administering oxygen therapy and during administering oxygen therapy), while presented moderate level of practice at domain (nursing intervention after administering oxygen therapy). Conclusion: The nurses ' knowledge and practices about oxygen therapy were inadequate. Recommendations: Conduct training sessions to improve the performance of the nursing staff on the correct use of oxygen therapy. We recommend researchers to do extensive research in the future on the subject of oxygen therapy, including an educational program.

Assessment of Nurse's Knowledge and Practice Regarding Oxygen Therapy at Teaching Hospitals in Al- Nasiriya City\ Iraq

Background: Oxygen therapy is considered the most common drug in the treatment of many life-threatening diseases such as respiratory failure, chronic obstructive pulmonary disease, and others. Particularly now, with the spread of the Coronavirus outbreak, it has become the main drug to save the patients' lives and care for them. As a result, the nurse should have more kills and experience to performing this procedure in the aim to maintain the patient's life safe and avoid complications associated with incorrect oxygen administration technique. Aims of the study: To assess nurses' knowledge and practice regarding oxygen therapy in (critical care units), (emergency units), (oncology units) at Al-Haboby Teaching Hospital and Al-Hussein Teaching Hospital in Al-Nasiriya City. Methodology: A descriptive research design was adopted to conduct this study during the period of (14 November 2020 to 20 March 2021).The study was purposive (non-probability) sample of (60) nurses who are working in (critical care units), (emergency units), (oncology units) at Al- Haboby Teaching Hospital and Al-Hussein Teaching Hospital in Al- Nasiriya City. A self-administered questionnaire was constructed by the researcher for the purpose of data collection regarding nurse's knowledge and practice about oxygen therapy. It consisted of three parts: Part I: Part one contains (12) item including demographic data, Part II: This part deals with nurse’s knowledge and consists of five domains, and Part III: Observational Checklist about nurse’s practice during oxygen administration, it contains (26) items. Study began after requested permission to use the tool. The validity of the study instrument (questionnaire) are determined by experts, who have more than five years’ experience in their fields to determine the clarity and adequacy of the questionnaire to achieve the study objectives. They are (8) faculty members of College of Nursing / University of Baghdad, (1) faculty members of College of Nursing /University of Karbala, (1) faculty member of College of Nursing /University of Thi-Qar, (2) specialized physician in Thoracic diseases and (2) Board anesthesia &amp;intensive care. The questionnaire was finalized after the pilot study was used to test the instrument, the results of the reliability for the questionnaire were the reliability of knowledge was r=0.832 and the reliability of practice by (intra observation) was r=0.821 it considered within the acceptable range and the questionnaires had an adequate level of internal consistency and equivalence measurability. The data were analyzed by applying descriptive and inferential data by application of statistical package for social science program (SPSS) version 23.0. Results: show that, the study sample was presented a low level of knowledge at all five domains related (general knowledge of oxygen therapy and recognizing hypoxemia, indications for acute oxygen therapy, oxygen prescription, and oxygen delivery practices). While in relation to practice, the sample presented low level of practice at both domains (before administering oxygen therapy and during administering oxygen therapy), while presented moderate level of practice at domain (nursing intervention after administering oxygen therapy). Conclusion: The nurses ' knowledge and practices about oxygen therapy were inadequate. Recommendations: Conduct training sessions to improve the performance of the nursing staff on the correct use of oxygen therapy. We recommend researchers to do extensive research in the future on the subject of oxygen therapy, including an educational program.

Oxygen in the acute care of adults : Short version of the German S3 guideline

HintergrundSauerstoff (O2) ist ein Arzneimittel mit spezifischen Eigenschaften, einem definierten Dosis-Wirkungs-Bereich und O2 hat unerwünschte Wirkungen. Im Jahr 2015 wurden 14 % einer Stichprobe von britischen Krankenhauspatienten mit Sauerstoff behandelt, davon hatten nur 42 % eine Verordnung. Gesundheitspersonal ist häufig unsicher über die Relevanz einer Hypoxämie und es besteht ein eingeschränktes Bewusstsein für die Risiken einer Hyperoxämie. In den letzten Jahren wurden zahlreiche randomisierte, kontrollierte Studien zur Sauerstofftherapie veröffentlicht.MethodenIm Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften diese S3-Leitlinie auf Basis einer Literaturrecherche bis zum 01.02.2021 entwickelt. Zur Literaturbewertung wurde das System des Oxford Centre for Evidence-Based Medicine (CEBM; „The Oxford 2011 Levels of Evidence“) verwendet. Die Bewertung der Evidenzqualität erfolgte anhand des Grading of Recommendations Assessment, Development and Evaluation (GRADE) und die Leitlinienempfehlungen wurden formal konsentiert.ErgebnisseDie Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Indikation für Sauerstoff ist hauptsächlich die Hypoxämie. Hypoxämie und Hyperoxämie sollten aufgrund der Assoziation mit einer erhöhten Sterblichkeit vermieden werden. Die Leitlinie empfiehlt Zielbereiche der Sauerstoffsättigung für die Sauerstoff-Akuttherapie ohne Differenzierung zwischen verschiedenen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisiko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort.FazitDies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet, und ist bis zum 30.06.2024 gültig.

Cold bubble humidification of low-flow oxygen does not prevent acute changes in inflammation and oxidative stress at nasal mucosa

Some clinical situations require the use of oxygen therapy for a few hours without hypoxemia. However, there are no literature reports on the effects of acute oxygen therapy on the nasal mucosa. This study aimed to evaluate the acute effects of cold bubble humidification or dry oxygen on nasal Inflammation, oxidative stress, mucociliary clearance, and nasal symptoms. This is a randomized controlled cross-sectional study in which healthy subjects were randomly allocated into four groups: (1) CA + DRY (n = 8): individuals receiving dry compressed air; (2) OX + DRY (n = 8): individuals receiving dry oxygen therapy; (3) CA + HUMID (n = 7): individuals receiving cold bubbled humidified compressed air; (4) OX + HUMID (n = 8): individuals receiving cold bubbled humidified oxygen therapy. All groups received 3 L per minute (LPM) of the oxygen or compressed air for 1 h and were evaluated: total and differential cells in the nasal lavage fluid (NLF), exhaled nitric oxide (eNO), 8-iso-PGF2α levels, saccharin transit test, nasal symptoms, and humidity of nasal cannula and mucosa. Cold bubble humidification is not able to reduced nasal inflammation, eNO, oxidative stress, mucociliary clearance, and nasal mucosa moisture. However, subjects report improvement of nasal dryness symptoms (P < 0.05). In the conclusion, cold bubble humidification of low flow oxygen therapy via a nasal cannula did not produce any effect on the nasal mucosa and did not attenuate the oxidative stress caused by oxygen. However, it was able to improve nasal symptoms arising from the use of oxygen therapy.

The Frequency of Persistent Symptoms after Acute COVID-19 among Iraqi Patients

Background: Post–coronavirus disease 2019 (COVID-19) symptoms tend to persist in many survivors of COVID-19. Objectives: To find out the prevalence of persistent symptoms that continue to appear after the eradication of the COVID-19 infection among Iraqi survivors. We hypothesized that wearing a mask during the COVID-19 pandemic may lead to a lesser viral load in an individual who gets infected, thereby leading to milder symptoms and manifestations. Materials and Methods: Overall, 70 consecutive Iraqi patients diagnosed with COVID-19 during the period from early August to late September 2020 were enrolled in the study, and on a mean of 31 days after recovery, they were assessed for persistent symptoms after the acute COVID-19 infection. Results: The mean age ± SD was 40.5 ± 16.1 years old. On a mean of 31 days post-COVID-19 recovery, 91.4% of all the patients had at least one persistent symptom. The most common persistent symptoms recorded were fatigue (42.9%), dyspnea (32.8%), and chest pain (25.7%). There was a statistically significant difference (P = 0.002) among patients with hypertension, among whom 45.5% had persistent palpitation. Among patients with ischemic heart disease, 25% had constant chest pain, and 37.5% complained of palpitation post-recovery. Patients who had used masks before infection (85.4%) were managed at home, and they did not require hospitalization. Overall, 45.7% of those dyspneic during the infection period were still complaining of exertional dyspnea post-recovery (P = 0.041). Conclusion: A large proportion of the Iraqi patients with COVID-19 infection had persistent symptoms after recovery. The use of a mask before infection showed mild symptoms during the acute phase, and hospitalization or oxygen therapy was not indicated for them.

Markers of cardiovascular risk and their reversibility with acute oxygen therapy in Kyrgyz highlanders with high altitude pulmonary hypertension

BackgroundHigh altitude pulmonary hypertension (HAPH), a chronic altitude related illness, is associated with hypoxemia, dyspnea and reduced exercise performance. We evaluated ECG and pulse wave-derived markers of cardiovascular risk in highlanders with HAPH (HAPH+) in comparison to healthy highlanders (HH) and lowlanders (LL) and the effects of hyperoxia. MethodsWe studied 34 HAPH+ and 54 HH at Aksay (3250m), and 34 LL at Bishkek (760m), Kyrgyzstan. Mean pulmonary artery pressure by echocardiography was mean±SD 34±3, 22±5, 16±4mmHg, respectively (p<0.05 all comparisons). During quiet rest, breathing room air or oxygen in randomized order, we measured heart-rate adjusted QT interval (QTc), an ECG-derived marker of increased cardiovascular mortality, and arterial stiffness index (SI), a marker of cardiovascular disease derived from pulse oximetry plethysmograms. ResultsPulse oximetry in HAPH+, HH and LL was, mean±SD, 88±4, 92±2 and 95±2%, respectively (p<0.05 vs HAPH+, both comparisons). QTc in HAPH+, HH and LL was 422±24, 405±27, 400±28ms (p<0.05 HAPH+ vs. others); corresponding SI was 10.5±1.9, 8.4±2.6, 8.5±2.0m/s, heart rate was 75±8, 68±8, 70±10 bpm (p<0.05, corresponding comparisons HAPH+ vs. others). In regression analysis, HAPH+ was an independent predictor of increased QTc and SI when controlled for several confounders. Oxygen breathing increased SI in HH but not in HAPH+, and reduced QTc in all groups. ConclusionsOur data suggest that HAPH+ but not HH may be at increased risk of cardiovascular mortality and morbidity compared to LL. The lack of a further increase of the elevated SI during hyperoxia in HAPH+ may indicate dysfunctional control of vascular tone and/or remodelling.

Acute oxygen therapy: a cross-sectional study of prescribing practices at an English hospital immediately before COVID-19 pandemic

ABSTRACT Background Approximately 14% of UK hospital in-patients receive supplemental oxygen therapy, only 57% have valid prescriptions. Oxygen must be optimally prescribed to ensure maximal therapeutic response whilst minimizing adverse outcomes (including fatality). This study investigates prescription compliance. Methods All adults admitted to medical wards (18 February to 3 March 2020) were included. Analyses present proportions, descriptive statistics, and hypothesis testing. Ethical approval was unnecessary for this audit. Results Of the 636 patients admitted, 66 (10%) were receiving oxygen therapy. Ages ranged from 34 to 100 years with 36 (54.5%) males and 30 (45.5%) females. The prescription was not documented in the oxygen section of the drug chart (n = 37, 56.1%, p = 0.389), nor did it have the physicians signature (n = 40, 60.6%, p = 0.110) nor date (n = 46, 69.7%, p = 0.002). Thirteen chronic obstructive pulmonary disease (COPD) patients (19.7%) were at risk of hypercapnic failure (p = 1.582x10−6). Target oxygen saturation (SpO2) range had been documented for 30 (45.5%) patients. A target SpO2 range of 88–92% was documented for 9 patients (13.6%), a 94–98% range documented for 11 patients (16.7%). All patients had an invalid prescription. Conclusion We present real-world practice in naturalistic settings, immediately before pandemic-lockdown. Enhanced compliance is advocated to reduce risks of harm and mortality.

Understanding Clinicians' Perceived Barriers and Facilitators to Optimal Use of Acute Oxygen Therapy in Adults.

BackgroundSupplemental oxygen is commonly administered to patients in acute care. It may cause harm when used inappropriately. Guidelines recommend prescription of acute oxygen, yet adherence is poor. We aimed to identify barriers and facilitators to practicing in accordance with the evidence-based Thoracic Society of Australia and New Zealand (TSANZ) oxygen guideline, and to determine the beliefs and attitudes relating to acute oxygen therapy.MethodsA national cross-sectional survey was conducted. The survey consisted of 3 sections: (1) introduction and participant characteristics; (2) opinion/beliefs, knowledge and actions about oxygen therapy and other drugs; and (3) barriers and facilitators to use of the TSANZ guideline. Convenience sampling was employed. A paper-based survey was distributed at the TSANZ Annual Scientific Meeting. An online survey was emailed to the TSANZ membership and to John Hunter Hospital's clinical staff.ResultsResponses were received from 133 clinicians: 52.6% nurses, 30.1% doctors, and 17.3% other clinicians. Over a third (37.7%) were unaware/unsure of the oxygen guideline’s existence. Most (79.8%) believe that oxygen is a drug and should be treated as one. Most (92.4%) stated they only administered it based on clinical need. For four hypothetical cases, there was only one where the majority of participants identified the optimal oxygen saturation. A number of barriers and facilitators were identified when asked about practicing in accordance with the TSANZ guideline. Lack of oxygen equipment, getting doctors to prescribe oxygen and oxygen being treated differently to other drugs were seen as barriers. The guideline itself and multiple clinician characteristics were considered facilitators.ConclusionThere is discordance between clinicians’ beliefs and actions regarding the administration of oxygen therapy and knowledge gaps about optimal oxygen therapy in acute care. Identified barriers and facilitators should be considered when developing evidence-based guidelines to improve dissemination and knowledge exchange.

Urgent need for greater knowledge of acute oxygen therapy among French paediatric residents.

Urgent need for greater knowledge of acute oxygen therapy among French paediatric residents.

Development and validation of a questionnaire to assess the doctors and nurses knowledge of acute oxygen therapy.

BackgroundPrescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health care providers on various aspects of oxygen therapy, and this may be a barrier to optimal oxygen administration. Hence, it is essential to ascertain providers’ knowledge of acute oxygen therapy so that appropriate educational interventions are instituted for better delivery. There is no available validated instrument to assess knowledge of acute oxygen therapy. The study aimed to develop, validate and evaluate the test-retest reliability of a questionnaire to determine the doctors and nurses understanding of acute oxygen therapy.MethodsThis study involved the development of the questionnaire contents by a literature review, assessment of face validity (n = 5), content validity, using a panel of experts (n = 10), item analysis and test-retest reliability among a sample (n = 121) of doctors and nurses.ResultsFace validity indicated that the questionnaire was quick to complete (10–15 min), most items were easy to follow and comprehensible. The global content validity index (S-CVI) was 0.85. The test-retest reliability statistics showed a kappa coefficient of 0.546–0.897 (all P<0.001) and percentage agreement of 80–98.3% indicating high temporal stability in the target population. In total, 90% of the items fulfilled the reliability acceptance criteria. Item discrimination analysis showed that most questions were at an acceptable level. The final questionnaire included 37 item questions and eight sections.ConclusionThe designed questionnaire is a reliable and valid tool for assessing knowledge of acute oxygen therapy among doctors and nurses.

Acute Oxygen Therapy

Acute Oxygen Therapy

Acute oxygen therapy: an audit of prescribing and delivery practices in a tertiary hospital in Perth, Western Australia.

Oxygen is a widely used drug in the hospital setting. However, international audits suggest that oxygen administration practices are often not compliant with prescribed standards. This can place patients at risk and cause serious adverse events. To analyse data related to recent practices of oxygen prescription and administration at Royal Perth Hospital (RPH), Western Australia. The results of this audit aim to guide further research on possible interventional studies implementing key solutions. All patients who received care in the Acute Medical Unit at RPH between 1 September and 14 September 2015 were included in this audit. Patients who were given supplemental oxygen during their admission were selected for further review of records. Appropriate medically indicated target oxygen saturations for each patient were judged under consultation with a respiratory specialist. A total of 65 patients received oxygen supplementation within the study period; 36 of these patients (55.4%) had target oxygen saturations prescribed by doctors, and 25% of the prescribed targets were judged to be inappropriate. In total, 49 patients (75.4%) were exposed to a potential risk from oxygen therapy due to prescription error and/or delivery error. A real risk was identified in 19 patients (29.2%) as they received oxygen at levels outside their appropriate medically indicated target range. The current practices of oxygen prescription and administration within RPH are suboptimal. Patients are placed at risk of oxygen toxicity due to deviation from oxygen prescription guidelines.

Early Onset of Ocular Neovascularization After Hyperbaric Oxygen Therapy in a Patient With Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) is an infarction to the retina that results in acute, frequently severe vision loss. Long-term complications such as ocular neovascularization (ONV) can occur and result in neovascular glaucoma and vitreous hemorrhage. Recent studies have explored acute hyperbaric oxygen (HBO) therapy as a promising treatment for CRAO to improve long-term vision potential; however, its effects on CRAO complications have not been well characterized. This study was conducted to better characterize the effects of HBO therapy on complications from CRAO. We present a unique case of ONV in an eye within 1 month after successfully completing acute HBO therapy for a CRAO, highlighting the importance of routine monitoring in this unique population.

145 Systematic delivery approach at 37 weeks of gestation in mild and severe preeclampsia: Maternal and neonatal outcomes

Introduction Preeclampsia is associated with complications especially in severe forms. Recognize this condition can direct to adoption of different behaviors. Objectives Evaluate epidemiological characteristics and compare maternal and neonatal outcomes of mild and severe preeclampsia in pregnancies that results in delivery after 37 weeks of gestation. Methods Prospective study with 40 women was developed in Guilherme Alvaro Hospital-Santos/Brazil, during December/2015 and May/2016. Study group: 20 women with preeclampsia (13 mild and 7 severe), according to NHBPEP – National High Blood Pressure Education Program (2000) criteria and gestational age > 37 weeks. Control group: 20 pregnant women with single and live fetus, > 38 weeks, without comorbidities. Exclusion criteria for study group: twin pregnancy, fetal anomalies and gestational age under 37 weeks. Control group exclusion criteria: twin pregnancy, gestational age under 38 weeks, cesarean/forceps/induced vaginal delivery and comorbidities. Maternal variables: age, gestational age at delivery, previous pregnancy history, body mass index (BMI), comorbidities, length of hospital stay and intensive care unit (ICU) admission, previous preeclampsia and delivery route. Neonatal variables: birth weight, adequacy weight for gestational age, Apgar score, meconium fluid at delivery, intensive care unit admission, acute respiratory distress syndrome, cardiopulmonary arrest, jaundice, oxygen therapy and intrahospital mortality. The statistical comparisons were made using Fisher’s exact test and Tukey multiple comparisons method. The significance level was p 0,05. Results Comparison between the three groups in maternal and neonatal outcomes (* = p 0,05): Download : Download high-res image (199KB) Download : Download full-size image Conclusions The present study showed that the mild preeclampsia group has better results than the severe group in some variables. This first group had no need of mother ICU admission, their BMI is higher and was the group with more previous preeclampsia. The severe preeclampsia group has a significant level of arterial hypertension, stayed longer in the hospital and their newborn had presented more general complications. Data shows more favorable maternal and neonatal outcomes in the control group.

136 Systematic delivery approach at 37 weeks of gestation in preeclampsia: Maternal and neonatal outcomes

Introduction A systematic delivery approach in pregnant women diagnosed with preeclampsia could avoid risks to both mother and newborn. A study about these outcomes could guide this practice. Objectives Evaluate epidemiological characteristics and compare maternal and neonatal outcomes in gestations with and without preeclampsia. Methods Prospective study with 40 women was developed in Guilherme Alvaro Hospital- Santos/Sao Paulo/Brazil (December/2015–May/2016). Study group: 20 women with preeclampsia according to NHBPEP – National High Blood Pressure Education Program (2000), > 37 weeks. Control group: 20 pregnant women with single and live fetus, > 38 weeks, without comorbidities. Exclusion criteria for study group: twin pregnancy, fetal anomalies and gestational age under 37 weeks. Control group exclusion criteria: twin pregnancy, gestational age under 38 weeks, cesarean/ forceps/ induced vaginal delivery and comorbidities. Maternal variables: age, gestational age at delivery, previous pregnancy history, body mass index (BMI), comorbidities, length of hospital stay, intensive care unit admission, previous preeclampsia and delivery route. Neonatal variables: birth weight, adequacy weight for gestational age, Apgar score, meconium fluid at delivery, intensive care unit admission, acute respiratory distress syndrome, cardiopulmonary arrest, jaundice, oxygen therapy and intrahospital mortality. The statistical comparisons were made using Fisher’s exact test and Tukey multiple comparisons method. Data analysis was performed by calculating odds ratio adoption hypothesis and the rejection level of 0,05. Results Comparison between preeclampsia and normal pregnancies in maternal and neonatal outcomes (* = p 0 , 05 ): Download : Download high-res image (201KB) Download : Download full-size image Conclusions Preeclampsia is more often associated with maternal and neonatal adverse outcomes when compared to the healthy pregnancies. Women diagnosed with preeclampsia appears to be older, have higher body mass index, longer hospital stay (including intensive care unit) and have previous preeclampsia more often than those without this comorbidity. There is a lack of significance in comparing neonatal outcomes between the systematic delivery approach at 37 weeks and the control groups.