Administration Of Oxygen Therapy Research Articles

Pitfalls in Nurses' Performance regarding Oxygen Therapy Administration at Neonatal Intensive Care Units : An Assessment Study

Pitfalls in Nurses' Performance regarding Oxygen Therapy Administration at Neonatal Intensive Care Units : An Assessment Study

Hyperoxemia and hypoxemia impair cellular oxygenation: a study in healthy volunteers.

Administration of oxygen therapy is common, yet there is a lack of knowledge on its ability to prevent cellular hypoxia as well as on its potential toxicity. Consequently, the optimal oxygenation targets in clinical practice remain unresolved. The novel PpIX technique measures the mitochondrial oxygen tension in the skin (mitoPO2) which allows for non-invasive investigation on the effect of hypoxemia and hyperoxemia on cellular oxygen availability. During hypoxemia, SpO2 was 80 (77-83)% and PaO2 45(38-50) mmHg for 15min. MitoPO2 decreased from 42(35-51) at baseline to 6(4.3-9)mmHg (p < 0.001), despite 16(12-16)% increase in cardiac output which maintained global oxygen delivery (DO2). During hyperoxic breathing, an FiO2 of 40% decreased mitoPO2 to 20 (9-27) mmHg. Cardiac output was unaltered during hyperoxia, but perfused De Backer density was reduced by one-third (p < 0.01). A PaO2 < 100mmHg and > 200mmHg were both associated with a reduction in mitoPO2. Hypoxemia decreases mitoPO2 profoundly, despite complete compensation of global oxygen delivery. In addition, hyperoxemia also decreases mitoPO2, accompanied by a reduction in microcirculatory perfusion. These results suggest that mitoPO2 can be used to titrate oxygen support.

An Observational Study of Fungal Infections in COVID-19: Highlighting the Role of Mucormycosis in Tertiary Healthcare Settings.

Background Fungal infections, especially mucormycosis, have remarkably surged during the coronavirus disease 2019 (COVID-19) era, especially during the second wave peak of the pandemic raising the concern of the clinicians for the admitted patients. Steroid therapy, diabetes, and other immunocompromised states are more commonly associated with COVID-19-associated mucormycosis (CAM). Aim and objective The aim of this study is to ascertain the prevalence of fungal infections amidst the second wave of the COVID-19 pandemic and discern the associated risk factors. Materials and methods During the second peak of COVID-19, samples were received in the microbiology laboratory from all clinically suspected mucormycosis patients. These samples underwent processing for potassium hydroxide (KOH) wet mount, fungal cultureonSabouraud's dextrose agar (SDA) medium, and COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) testing.All relevant clinical and associated risk factors were tabulated and analyzed. Results Among the 107 suspected cases of mucormycosis, 39 (36.4%) were confirmed positive for COVID-19 via RT-PCR, while 68 (63.6%) tested negative. Males exhibited a predominant infection rate, with the rhinocerebral system being the most commonly affected site. Significantly higher mortality rates were observed in COVID-19-associated mucormycosis (CAM) patients (33.4%) compared to those without COVID-19 (5.9%), with a notable p-value of 0.0005. CAM patients also demonstrated a higher frequency of ICU admissions (77%) compared to non-COVID-19-associated mucormycosis patients (21.4%), a statistically significant finding (p-value of 0.007). Additionally, immunocompromised states, diabetes, and the administration of oxygen therapy were identified as significant risk factors in CAM (p < 0.05). Notably, mucormycosis accounted for the majority of fungal isolates (48.27%) among COVID-19 patients. Conclusion Mucormycosis infection is more commonly seen in COVID-19-infected patients as compared to non-COVID-19 patients, especially with comorbidities such as diabetes mellitus, steroid usage, and other immunocompromised states.

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 &lt; 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.

Knowledge, Attitude and Practice and Associated Factors on Oxygen Therapy Among Nurses and Midwives in Y12 HMC-2022 Gc

Background: Oxygen is an essential medical therapy which saves a lot of lives. It is administered as a corrective treatment for conditions resulting in hypoxia (low level of oxygen in the blood). So, the nurse should have more skills 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. Objective: The study was conducted to assess the level of knowledge, attitude and practice towards oxygen therapy administration and associated factors among nurses and midwives at Yekatit 12 Hospital Medical college in 2022. Method: To achieve the research objectives a hospital based cross-sectional study was applied. The sample size drawn was 198. Pertinent data for the study were gathered through structured questionnaires. Descriptive and multiple logistic regression were used in the analysis of independent and outcome variables. Result: Data is collected from 211 participants and my response rate is (198)93.8%. Among 198 nurse and midwives 50.5% were males, 49.5% with the range of 30-39yrs and most of them (48.5%) have work experience of 6-9yrs.The mean score of knowledge, attitude and practice were 5.7(SD=1.608),4.01(SD=1.837) and 14.5(3.49) respectively. It is found that the level of knowledge was adequate in 117(59.1%) and poor 81 (40.9%) of participants. Practical skill is found to poor in 63.1% of participants and factors associated with this were absences of oxygen therapy guide line, not participating in any training about oxygen therapy and supply of oxygen delivery system with P-value of 0.01, 0.02 and 0.002 respectively. work experience also contributes for poor practice. Conclusion: There is a clear practical gap among nurses and midwives working in Y12HMC and this study also shows as there is poor attitude in almost have of the participants which high compared to another research. The possible associated factors for poor practice were identified as work experience less than 1yr and absence of training and oxygen guideline. So, to enhance safe use of oxygen therapy the referral hospital needs to push its effort for improving the practice and attitude of nurses and midwives towards oxygen therapy by facilitating trainings, increases the availability of guideline and supply of oxygen.

Assessment of knowledge, attitude and practice for oxygen therapy among medical staff at the Colonial War Memorial Hospital in Fiji.

Oxygen therapy (OT) is a commonly prescribed essential medicine for people of all ages in the management of hypoxia. The adverse effects of inappropriate OT supplementation may be underestimated by health professionals and lead to poor health outcomes among hospitalised patients. Knowledge, attitude and practice (KAP) assessments of medical staff members to OT guidelines are essential to ensure optimal patient care. To perform a KAP assessment of OT administration among doctors and nurses employed at the national hospital of Fiji in 2021. Prospective cross-sectional study design. KAP assessment was performed with an online questionnaire and clinical observation. The study population (N = 116) consisted of doctors (20.7%) and nurses (79.3%) representing the acute medical, burns, cardiac care, intensive care, surgical and postanaesthetic recovery units. Overall, the proportion of participants who obtained a good score (>70%) was 87% for knowledge, 87.93% for attitudes and 84% for practice. Best knowledge scores were obtained for general OT indications (71%) and scenarios where immediate oxygen application is required (70%). Lowest knowledge scores were for OT contraindications (14%) and oxygen saturation for acute myocardial infarction (32%), asthma (36%) and healthy newborns (43%). The most positive attitudes were in response to the statement that OT guidelines are essential (96%). A total of 78 (80.4%) patients were being cared for with good OT practice. Good KAP scores were obtained for medical staff in Fiji regarding OT administration. Ongoing professional education activities should include updated training of OT contraindications and optimal oxygen saturation levels for special patient groups.

Clinical Efficacy of the Neutralizing Antibody Therapy Sotrovimab in Patients with SARS-CoV-2 Omicron BA.1 and BA.2 Subvariant Infections.

Sotrovimab, an antibody active against severe acute respiratory syndrome coronavirus 2 that neutralizes antibodies, reduced the risk of COVID-19-related hospitalization or death in studies conducted before the emergence of the Omicron variant. The objective of this study is to evaluate the clinical efficacy of sotrovimab in patients with mild to moderate COVID-19 Omicron BA.1 and BA.2 subvariant infections using a propensity score matching method. The propensity score-matched cohort study population was derived from patients who received sotrovimab. We derived a comparator group from an age- and sex-matched population who were recuperating in a medical facility after COVID-19 infection or from elderly person entrance facilities during the same period who were eligible for but did not receive sotrovimab treatment. In total, 642 patients in the BA.1 subvariant group and 202 in the BA.2 subvariant group and matched individuals were analyzed. The outcome was the requirement for oxygen therapy. In the treatment group, 26 patients with the BA.1 subvariant and 8 patients with the BA.2 subvariant received oxygen therapy. The administration of oxygen therapy was significantly lower in the treatment group than in the control group (BA.1 subvariant group, 4.0% vs. 8.7%, p = 0.0008; BA.2 subvariant group, 4.0% vs. 9.9%, p = 0.0296). All these patients were admitted to our hospitals and received additional therapy and then recovered. No deaths were observed in either group. Our results demonstrate that the sotrovimab antibody treatment may be associated with a reduction in the requirement for oxygen therapy among high-risk patients with mild to moderate COVID-19 Omicron BA.1 and BA.2 subvariants.

Use of lung ultrasound in school-aged children with wheezing.

There is limited information available on fast and safe bedside tools that could help clinicians establish whether the pathological process underlying cases of wheezing is due to asthmatic exacerbation, asthmatic bronchitis, or pneumonia. The study's aim was to characterize Lung Ultrasound (LUS) in school-aged children with wheezing and evaluate its use for their follow-up treatment. We carried out a cross-sectional study involving 68 consecutive outpatients (mean age 9.9 years) with wheezing and suggestive signs of an acute respiratory infection. An expert sonographer, blinded to all subject characteristics, clinical course, and the study pediatrician's diagnosis, performed an LUS after spirometry and before BDT. The severity of acute respiratory symptoms was determined using the Pediatric Respiratory Assessment Measure (PRAM) score. The LUS was positive in 38.2% (26/68) of patients [12 (46.1%) with multiple B-lines, 24 (92.3%) with consolidation, and 22 (84.6%) with pleural abnormalities]. In patients with pneumonia, asthmatic bronchitis, and asthma, the percentages of those patients with a positive LUS were 100%, 57.7%, and 0%, respectively. Of note, patients with a positive LUS were associated with an increased need for hospital admission (30.8% vs. 2.4%, p = 0.001), administration of oxygen therapy (14.6% vs. 0%, p = 0.009), oral corticosteroids (84.6% vs. 19.0%, p < 0.001), and antibiotics (88.5% vs. 11.9%, p < 0.001); and a higher median value of PRAM score (4.0 (2.0-7.0) vs. 2.0 (1.0-5.0); p < 0.001). Our findings would suggest the use of LUS as a safe and cheap tool used by clinicians to define the diagnosis of school-aged children with wheezing of unknown causes.

Oxygen as a drug and scarce commodity: Do we use it rationally?

BackgroundMedical grade oxygen is classified as a drug and needs to be prescribed by a qualified healthcare professional. Oxygen therapy is prescribed to people who cannot maintain normal blood oxygen saturation while breathing atmospheric air. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of the rational use of this scarce commodity. This study investigated oxygen therapy practices in adult ward patients.MethodsA cross-sectional study design with an analytical component was used in the adults wards at a National District Hospital and the Pelonomi Academic Hospital in Bloemfontein. Data were collected from patient files, interviews and oxygen measurements of adult patients that received oxygen.ResultsOne hundred and fifteen patients were included in the study, of whom 47.0% received oxygen without an oxygen prescription. Around 62.3% of the patients with prescriptions did not receive oxygen as prescribed. The prescriptions and oxygen administration for COVID-19 patients were better than for non–COVID-19 patients. A quarter of the patients possibly received oxygen therapy unnecessarily.ConclusionPoor oxygen therapy practices were identified, including prescription errors, oxygen administration errors and oxygen wastage. A protocol should be developed and implemented for the prescription and administration of oxygen therapy. Training should occur to prevent oxygen wastage.ContributionThis study highlighted poor oxygen practices and prescriptions, as well as oxygen wastage in the absence of local oxygen therapy guidelines.

Clinical efficacy of casirivimab-imdevimab antibody combination treatment in patients with COVID-19 Delta variant

IntroductionCasirivimab-imdevimab, an antibody cocktail containing two severe acute respiratory syndrome coronavirus 2 neutralizing antibodies, reduces the viral load and the risk of coronavirus disease 2019 (COVID-19)-related hospitalization or death. The objective of this study was to evaluate the clinical efficacy of casirivimab-imdevimab in patients with COVID-19 Delta variant in Japan. MethodsThis study was conducted at five institutions and assessed a total of 461 patients with COVID-19 who met the inclusion criteria. The treatment group received a dose of casirivimab-imdevimab consisting of a cocktail of two monoclonal antibodies, (casirivimab 600 mg and imdevimab 600 mg intravenously). The control consisted of age- and sex-matched COVID-19 patients (n = 461) who sufficed the inclusion criteria but did not receive casirivimab-imdevimab. The outcome was the requirement of oxygen therapy. ResultsIn the treatment group, patients received oxygen therapy (n = 30), nasal canula (n = 23), high flow nasal cannula (n = 5), and mechanical ventilation (n = 2). In the control group, patients received oxygen therapy (n = 56), nasal canula (n = 45), high flow nasal cannula (n = 8), and mechanical ventilation (n = 3). The administration of oxygen therapy was significantly lower in the treatment group than the control group (6.5% vs. 12.1%, P = 0.0044). All these patients admitted to our hospitals and received additional therapy and recovered. ConclusionsOur results demonstrate that the casirivimab-imdevimab combination antibody treatment is associated with reduced rates of requiring oxygen therapy among high-risk patients with COVID-19 Delta variant.

Decentralizing oxygen availability and use at primary care level for children under-five with severe pneumonia, at 12 Health Centers in Ethiopia: a pre-post non-experimental study

BackgroundPneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths in children under the age of five. Hypoxemia is a major cause of death in patients suffering from pneumonia. There is strong evidence that using pulse oximetry and having reliable oxygen sources in health care facilities can reduce deaths due to pneumonia by one-third. Despite its importance, hypoxemia is frequently overlooked in resource-constrained settings. Aside from the limited availability of pulse oximetry, evidence showed that healthcare workers did not use it as frequently to generate evidence-based decisions on the need for oxygen therapy. As a result, the goal of this study was to assess the availability of medical oxygen devices, operating manuals, guidelines, healthcare workers’ knowledge, and skills in the practice of hypoxemia diagnosis and oxygen therapy in piloted health centers of Ethiopia.MethodsA pre-post non-experimental study design was employed. An interviewer-administered questionnaire was used to collect primary data and review medical record charts. A chi-square test with a statistical significance level of P < 0.05 was used as a cut-off point for claiming statistical significance.ResultsEighty one percent of healthcare workers received oxygen therapy training, up from 6% at baseline. As a result of the interventions, knowledge of pulse oximetry use and oxygen therapy provision, skills such as oxygen saturation and practices of oxygen therapy have significantly improved among healthcare workers in the piloted Health Centers. In terms of availability of oxygen devices (e.g. cylinders, concentrators, and pulse oximeters) in the facilities, seven (58%) facilities did not have any at baseline, but due to the interventions, all facilities were equipped with the oxygen devices.ConclusionsGiven the prevalence of pneumonia and hypoxemia, a lack of access to oxygen delivery devices, as well as a lack of knowledge and skills among healthcare workers in the administration of oxygen therapy, may represent an important and reversible barrier to improving child survival. Therefore, scaling up clinician training, technical support, availability of oxygen devices, guidelines, manuals, strengthening maintenance schemes, and close monitoring of healthcare workers and health facilities is strongly advised.

Study of Lopinavir/Ritonavir in Severe COVID-19 Patients with Comorbid Hypertension and Diabetes Mellitus

Background: Lopinavir/ritonavir is an antiviral studied for its effectiveness in healing severe COVID-19 infection; however, it remains debated. This study determined the efficacy and evaluated the side effects of lopinavir/ritonavir on severe COVID-19 patients with comorbid hypertension and diabetes mellitus. Methods: Retrospective data collection was conducted from June to December 2020. The data were then analyzed descriptively. Severe COVID-19 patients with hypertension and diabetes mellitus who received lopinavir/ritonavir were grouped into groups A, B, C, D and observed based on other pharmaceutical therapies (antibiotics, corticosteroids, anticoagulants, multivitamins and supplements, comorbid therapy, and symptomatic therapy) obtained. The efficacy of lopinavir/ritonavir was identifiable through RT-PCR, oxygenation saturation, and chest X-ray. The side effects of lopinavir/ritonavir were also be evaluated. Results: Only 21 total sample met the inclusion criteria. The oral administration of lopinavir/ritonavir (2 x 400/100 mg) was effective in groups A, B, C, and D whose negative RT-PCR results were respectively 10%, 48%, 5%, and 14%; normal oxygen saturation with the administration of oxygen therapy was 10%, 33%, 5%, and 5%, respectively; and chest X-ray improvement was 10%, 29%, 5%, and 14%, respectively. Lopinavir/ritonavir could increase SGOT (46%), SGPT (27%), as well as a QT interval prolongation (5%). Conclusion: The administration of lopinavir/ritonavir is effective to rule out negative RTPCR results, improve chest X-ray imaging and oxygen saturation. Monitoring side effects merits more attention to avoid those potential side effects of the therapies

Cross-sectional study of the ambulance transport between healthcare facilities with medical support via telemedicine: Easy, effective, and safe tool.

Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine are unknown. This was a retrospective study with a single telemedicine center reference for satellite emergency departments of the same hospital. The study population was all critically ill patients admitted to one of the peripheral units from November 2016 to May 2020 and who needed to be transferred to the main building. Telemedicine-assisted transportation was performed by an emergency specialist. The inclusion criteria included patients above the age of 15 and initial stabilization performed at the emergency department. Unstable, intubated, ST-elevation myocardial infarction and acute stroke patients were excluded. There was a double-check of safety conditions by the nurse and the remote doctor before the ambulance departure. The primary endpoint was the number of telemedicine-guided interventions during transport. 2840 patients were enrolled. The population was predominantly male (53.2%) with a median age of 60 years. Sepsis was the most prevalent diagnosis in 28% of patients, followed by acute coronary syndromes (8.5%), arrhythmia (6.7%), venous thromboembolism (6.1%), stroke (6.1%), acute abdomen (3.6%), respiratory distress (3.3%), and heart failure (2.5%). Only 22 (0.8%) patients required telemedicine-assisted support during transport. Administration of oxygen therapy and analgesics were the most common recommendations made by telemedicine emergency physicians. There were no communication problems in the telemedicine-assisted group. Telemedicine-assisted ambulance transportation between healthcare facilities of stabilized critically ill patients may be an option instead of an onboard physician. The frequency of clinical support requests by telemedicine is minimal, and most evaluations are of low complexity and easily and safely performed by trained nurses.

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.

Prehospital emergency care of patients exposed to poisoning: Assessment of epidemiological, clinical characteristics and quality of care

ObjectiveTo describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients. MethodA one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients. ResultsThe study included a total of 254 patients, with a median age of 14 years old (p25-75=7–16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9–13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3–7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set. ConclusionsPaediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement.

Bilateral atrial thrombosis in an African hedgehog (Atelerix albiventris) with cardiomyopathy, endometrial hyperplasia, and left cystic ovary

ABSTRACT A 2-year-old female African pygmy hedgehog (Atelerix albiventris) presented to emergency for anorexia, lethargy and vulvar discharge. Tranquilization with midazolam, administration of oxygen therapy and facemask anesthesia with isoflurane were used for radiography study which showed increased radio-opacity and silhouette sign in the thoracic cavity. The patient underwent cardio-respiratory arrest during the performance of TFAST echocardiography. TFAST confirmed pleural effusion, a nodule in the chamber of the right atrium. Abdominal ultrasound revealed two fluid filled structures compatible with left ovarian cysts. Necropsy confirmed dilated cardiomyopathy, bilateral atrial thrombi, endometrial hyperplasia and two left ovarian cysts.

Current practice of prescription and administration of oxygen therapy: An observational study at a single teaching hospital.

ObjectivesOxygen therapy, commonly used clinically, should be administered according to the physician's prescription; however, accumulating evidence signals some degree of inaccuracy in this perspective. This study aimed to evaluate the current practice of prescription and administration of oxygen therapy.MethodsThis observational study was conducted at a teaching hospital in the Eastern province of KSA. All inpatients in general wards who were on supplemental oxygen (O2) were included. Patient's demographic data and physician's prescription items were collected from patient medical charts and the respiratory care (RC) department charts. Oxygen administration to inpatients was monitored and matched with oxygen prescriptions recorded on the medical and RC charts.ResultsAmong 152 inpatients, 21 were on supplemental O2. Of these, 20 had written prescriptions in their medical charts, but only 18 had information recorded in the RC charts. Of the 5 items required by hospital guidelines for oxygen prescription, 30% of patients had 3 items; whereas 70% of patients had only 2 items. Mode of oxygen delivery was recommended in all physicians' prescriptions, but flow rate and FiO2 were ordered in only 30% of prescriptions. Among the 6 patients with a written record of target SpO2 range, 2 had a value outside of the target range and 2 of 6 patients had a flow rate that differed from the prescribed rate.ConclusionCurrent practice for oxygen therapy prescription and administration was suboptimal. Nation-wide investigations and remediations of oxygen therapy practice is needed to improve patient care.

Efficiency of oxygen therapy by head box for acute respiratory failure in infants

Oxygen therapy is the main treatment method for acute respiratory failure in children. The method consisting in the administration of oxygen therapy by head box to infants is frequently used in pediatric practice. Objectives. To evaluate the efficiency of oxygen therapy administered by head box to infants suffering from pneumonic acute respiratory failure by comparing two methods for measuring hemoglobin oxygen saturation: in arterialized capillary blood and by pulse oximetry. Material and method. 30 infants suffering from pneumonic acute respiratory failure were studied. We used a clinical appraisal score for acute respiratory failure, which appraises respiratory rate, nasal flaring, recession, cyanosis, sensorial, before and after oxygen therapy. In arterialized capillary blood we measured partial pressure of oxygen and hemoglobin oxygen saturation, and we used an Automatic Blood Gas System analyzer. We also measured hemoglobin oxygen saturation using a pulse oximeter. Determinations were made before the initiation of oxygen therapy, and 30 minutes and 60 minutes after the initiation of oxygen therapy. Results. As compared to the baseline values, determined before the initiation of oxygen therapy, we recorded a statistically significant improvement in the clinical score both after 30 minutes and 60 minutes from the initiation of oxygen therapy (p&lt;0.001). The improvement was greater after 60 minutes. The increase in the partial pressure of oxygen was statistically significant both at the 30 minute and 60 minute determination (p&lt;0.001). Both methods of SaO2 measurement recorded statistically significant increases (p&lt;0.001) in this variable after 30 and 60 minutes, respectively. Conclusions. Oxygen therapy administered by head box improves acute respiratory failure appraised by clinical score. The administration of oxygen therapy by head box to infants significantly increases the values of partial pressure of oxygen and hemoglobin oxygen saturation measured in capillary blood, as well as the values of hemoglobin oxygen saturation determined by pulse oximeter both after 30 minutes and after 60 minutes. The increases in the three parameters are larger after 60 minutes. There is statistically significant concordance between the values of hemoglobin oxygen saturation determined in capillary blood and by pulse oximetry at all determinations.

A comparison of ambulance responses to incidents of Medical Emergency Teams led by nurses and paramedics––A retrospective single-center study

BackgroundIn Poland there are currently two main types of Medical Emergency Team: basic, run by nurses or paramedics, and specialist, led by physicians. They differ not only in professional qualifications but also in their terms of reference. ObjectivesWe compared the responses to incidents of Medical Emergency Teams led by nurses and paramedics, in terms of the frequency of pharmacotherapy use and medical rescue activities. Study designAmbulance call reports. SettingsMedical Emergency Teams in Eastern Poland. ParticipantsMedical Emergency Teams led by nurses or paramedics. Exclusion criteria were cancelation of calls by the dispatcher, calls with no patient on the scene, and neonatal and interhospital transportation. MethodsA retrospective analysis of ambulance call reports. A comparison of actions of nurses and paramedics taken in the field, and decisions concerning transportation of the patient to a hospital or leaving the home were collected. ResultsOf 1115 Medical Emergency Teams calls, those led by paramedics (60.5%) were more common. Paramedics, more often than nurses, provided aid solely in the field—27.5% and 16.0%, respectively—and less frequently transported patients to the hospital—38.5% and 50.7%, respectively. Significant differences in administration of oxygen therapy and analgesics were identified; paramedics used them more often than nurses. Paramedics used cervical collars, 3.6% and 1.1% (p=0.01), respectively, and performed 12-lead electrocardiograms, 4.7% and 1.4% (p=0.002), respectively, significantly more frequently than did nurses. ConclusionsDespite the comparable competency of paramedics and emergency nurses in Poland, Medical Emergency Teams’ activities varied depending on whether a nurse or a paramedic was the team leader. It is recommended that further in-depth research is conducted in this area.

The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital

To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST(2) ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. Interrupted time series analysis. A rural Australian hospital. All registered nurses (Division 1) employed on an acute medical/surgical ward. The FIRST(2) ACT simulation program. Appropriate frequency of a range of observations and administration of oxygen therapy. Thirty-four nurses participated (83% of eligible nurses) in the FIRST(2) ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. FIRST(2) ACT was associated with measurable improvements in nursing practice.