Oxygen Requirements for Acutely and Critically Ill Patients

Oxygen administration is often assumed to be required for all patients who are acutely or critically ill. However, in many situations, this assumption is not based on evidence | Critical Care Nurse

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Injured body tissues and cells throughout the body respond both beneficially and adversely to delivery of supplemental oxygen. Available evidence indicates that oxygen administration is not warranted for patients who are not hypoxemic, and hyperoxia may contribute to increased tissue damage and mortality. Nurses must be aware of implications related to oxygen administration for all types of acutely and critically ill patients. These implications include having knowledge of oxygenation processes and pathophysiology; assessing global, tissue, and organ oxygenation status; avoiding either hypoxia or hyperoxia; and creating partnerships with respiratory therapists. Nurses can contribute to patients’ oxygen status well-being by being proficient in determining each patient’s specific oxygen needs and appropriate oxygen administration.

Full reference: Siela, D. & Kidd, M. (2017) Oxygen Requirements for Acutely and Critically Ill Patients. Critical Care Nurse. Vol. 37 (no. 4) pp.  58-70

High-flow nasal cannula oxygen therapy vs conventional oxygen therapy in cardiac surgical patients: A meta-analysis

This article is to be published in the Journal of Critical Care.  The full text of the article can be accessed via this link.

Introduction:  The use of high-flow nasal cannula (HFNC) for the treatment of many diseases has gained increasing popularity. In the present meta-analysis, we aimed to assess the efficacy and safety of HFNCs compared with conventional oxygen therapy (COT) in adult postextubation cardiac surgical patients.

Method:  We reviewed the Embase, PubMed, Cochrane Central Register of Controlled Trials, Wanfang databases, and the China National Knowledge Infrastructure. Two investigators independently collected the data and assessed the quality of each study. RevMan 5.3 was used for the present meta-analysis.

Results:  We included 495 adult postextubation cardiac surgical patients. There was no significant heterogeneity among the studies. Compared with COT, HFNCs were associated with a significant reduction in the escalation of respiratory support (risk ratio, 0.61; 95% confidence interval [CI], 0.46-0.82; z = 3.32, P < .001). There were no significant differences in the reintubation rate (risk ratio, 0.96; 95% CI, 0.04-24.84; z = 0.02, P = .98) or length of intensive care unit stay (weighted mean difference, 0.13; 95% CI, −0.88 to 7.92; z = 1.57, P = .12) between the 2 groups. No severe complications were reported in either group.

Conclusions:  The HFNC could reduce the need for escalation of respiratory support compared with COT, and it could be safely administered in adult postextubation cardiac surgical patients.

Non-invasive monitoring of oxygen delivery in acutely ill patients: new frontiers

Annals of Intensive Care 2015, 5:24

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Hypovolemia, anemia and hypoxemia may cause critical deterioration in the oxygen delivery (DO2 ). Their early detection followed by a prompt and appropriate intervention is a cornerstone in the care of critically ill patients. And yet, the remedies for these life-threatening conditions, namely fluids, blood and oxygen, have to be carefully titrated as they are all associated with severe side-effects when administered in excess.

New technological developments enable us to monitor the components of DO 2 in a continuous non-invasive manner via the sensor of the traditional pulse oximeter. The ability to better assess oxygenation, hemoglobin levels and fluid responsiveness continuously and simultaneously may be of great help in managing the DO 2 .

The non-invasive nature of this technology may also extend the benefits of advanced monitoring to wider patient populations.

via Annals of Intensive Care | Full text | Non-invasive monitoring of oxygen delivery in acutely ill patients: new frontiers.