Efficiency of goal-directed oxygen delivery in ICU patients

Abstract

Background: Current clinical practice guidelines promote a goal-directed approach for oxygen delivery with respect to SpO₂ objectives. We evaluated the efficiency of a strategy based on goal-directed O₂ delivery in the ICU.

Methods: A group of 30 patients (Group 1) with a proven history of chronic obstructive pulmonary disease suffering from acute hypercarbic exacerbation was compared to 2 other groups of patients admitted for acute respiratory failure with no history of pulmonary disease: 30 patients requiring oxygen supply and/or non-invasive ventilation (Group 2) and 30 requiring invasive ventilation (Group 3). The delivery of oxygen was based on SpO₂ measurement: 88-94% for Group 1 and 90-96% for others. The time spent with an SpO₂ below, within and above the prescribed limits was collected.

Results: The mean time spent within the prescribed range was for Groups 1, 2 and 3, respectively as follows: 61.9% [60.5-63.2], 63.7% [62.3-65] and 56.4% [55.3-57.6] (P < 0.001 for each group). A history of chronic obstructive pulmonary disease was not correlated with better results (P = 0.11), while invasive ventilation was related to the time spent out of the prescribed range (P < 0.001; OR 1.3 [1.22-1.28]) especially in hyperoxaemia (40.7% [39.6-41.8] P < 0.001). Efficiency seems unrelated to nursing workload or night team exhaustion (r = -0.09, P = 0.77).

Conclusions: Goal-directed oxygen delivery based on SpO₂ objectives in ICU patients ensures that in only approximately 64% of the time, SpO₂ stays within the prescribed range.

Keywords: goal-oriented therapy; hyperoxaemia; hypoxaemia; mechanical ventilation; nurse protocol; oxygen therapy; pulse oximetry.