Attitudes of Dutch intensive care unit clinicians towards oxygen therapy

BACKGROUND

Over the last decade, there has been an increasing awareness for the potential harm of the administration of too much oxygen. We aimed to describe self-reported attitudes towards oxygen therapy by clinicians from a large representative sample of intensive care units (ICUs) in the Netherlands.

METHODS

In April 2019, 36 ICUs in the Netherlands were approached and asked to send out a questionnaire (59 questions) to their nursing and medical staff (ICU clinicians) eliciting self-reported behaviour and attitudes towards oxygen therapy in general and in specific ICU case scenarios.

RESULTS

In total, 1361 ICU clinicians (71% nurses, 24% physicians) from 28 ICUs returned the questionnaire. Of responding ICU clinicians, 64% considered oxygen-induced lung injury to be a major concern. The majority of respondents considered a partial pressure of oxygen (PaO2) of 6-10 kPa (45-75 mmHg) and an arterial saturation (SaO2) of 85-90% as acceptable for 15 minutes, and a PaO2 7-10 kPa (53-75 mmHg) and SaO2 90-95% as acceptable for 24-48 hours in an acute respiratory distress syndrome (ARDS) patient. In most case scenarios, respondents reported not to change the fraction of inspired oxygen (FiO2) if SaO2 was 90-95% or PaO2 was 12 kPa (90 mmHg).

CONCLUSION

A representative sample of ICU clinicians from the Netherlands were concerned about oxygen-induced lung injury, and reported that they preferred PaO2 and SaO2 targets in the lower physiological range and would adjust ventilation settings accordingly.

Comparison of intravascular ultrasonic findings after coronary balloon angioplasty evaluated in vitro with histology

This study investigated whether vascular damage and quantitative changes observed with intravascular ultrasound at the most stenotic site are representative of the ultimate outcome after coronary balloon angioplasty. Atherosclerotic coronary arteries (n = 40) were studied in vitro with intravascular ultrasound. From each vascular specimen, 10 corresponding intravascular ultrasound cross sections obtained before and after balloon angioplasty were selected for comparison with their histologic counterpart. Morphologic and quantitative data obtained from all cross sections were compared with data derived from the most stenotic site. The incidence of vascular damage (i.e., dissection, plaque rupture, and media rupture) at the most stenotic site was lower than that seen for each vascular specimen. The sensitivity of intravascular ultrasound in detecting these morphologic features for each vascular specimen was high for dissection and media rupture (79% and 76%, respectively), and low for plaque rupture (37%). After balloon angioplasty, quantitative changes seen at the most stenotic site were greater than those in all cross sections: free lumen area +58% versus +29%, media-bound area +17% versus +12%, and plaque area reduction -9% versus -6%, respectively. The increase in free lumen area was caused predominantly by media-bound area increase (81%) and to a lesser extent by plaque area decrease (19%). This study revealed that a higher incidence of vascular damage is found when the whole segment is analyzed rather than 1 single cross section at the most stenotic site. Quantitative effects of coronary balloon angioplasty seen with intravascular ultrasound were greater at the most stenotic site than at all cross sections.