Hintergrund Sauerstoff (O2) ist ein Arzneimittel mit spezifischen biochemischen und physiologischen Eigenschaften, einem definierten Dosis-Wirkungsbereich und mit unerwunschten Wirkungen. Im Jahr 2015 wurden 14 % von uber 55 000 Krankenhauspatienten in Grosbritannien mit O2 behandelt. Nur 42 % der Patienten hatten dabei eine O2-Verordnung. Gesundheitspersonal ist oft unsicher uber die Relevanz einer Hypoxamie, und es besteht ein eingeschranktes Bewusstsein fur die Risiken einer Hyperoxamie. In den letzten Jahren wurden zahlreiche randomisierte kontrollierte Studien zu Zielen der Sauerstofftherapie veroffentlicht. Eine nationale Leitlinie ist deswegen dringend erforderlich. Methoden Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften eine S3-Leitlinie entwickelt und im Juni 2021 veroffentlicht. Bis zum 1. 2. 2021 wurde eine Literaturrecherche durchgefuhrt, um 10 Schlusselfragen zu beantworten. Zur Klassifizierung von Studientypen hinsichtlich ihrer Validitat wurde das Oxford Centre for Evidence-Based Medicine (CEBM) System („The Oxford 2011 Levels of Evidence“) verwendet. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) wurde verwendet und zur Bewertung der Evidenzqualitat und zur Einstufung von Leitlinienempfehlungen wurde ein formaler Konsensbildungsprozess durchgefuhrt. Ergebnisse Die Leitlinie enthalt 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Uberwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Hauptindikation fur die O2-Therapie ist Hypoxamie. In der Akutmedizin sollten sowohl Hypoxamie als auch Hyperoxamie vermieden werden. Hyperoxamie scheint mit einer erhohten Sterblichkeit verbunden zu sein, insbesondere bei Patienten mit Hyperkapnie. Die Leitlinie empfiehlt Zielsauerstoffsattigung fur die Akuttherapie mit O2 ohne Differenzierung zwischen Diagnosen. Zielbereiche sind abhangig vom Hyperkapnierisko und Beatmungsstatus. Die Leitlinie bietet einen Uberblick uber verfugbare Sauerstoffzufuhrsysteme und enthalt Empfehlungen fur deren Auswahl basierend auf Patientensicherheit und -komfort. Fazit Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff auserklinisch und stationar anwendet. Sie ist bis zum 30. 06. 2024 gultig.

S3-Leitlinie Sauerstoff in der Akuttherapie beim Erwachsenen

Abstract Recently, health technology systems offering monitoring of the peripheral oxygen saturation level and automated oxygen administration (AOA) have emerged. AOA has been shown to reduce duration of hypoxemia and the length of hospital stay, but the patients’ perspective on AOA has not been investigated. This qualitative study, based on the interpretive description methodology, aimed to explore how patients hospitalized with exacerbation of chronic obstructive pulmonary disease (COPD) experience being treated with AOA. Eighteen patients treated with AOA were included in the study. Data was collected during admission or in the patients’ homes using semi-structured interviews focusing on patients’ experiences of AOA using the word “robot” as used by patients. The findings revealed two themes “adaptation of behavior to the robot” and “robots can make patients feel safe but not cared for” and six subthemes. Our findings illustrate how patients were willing to compromise their own therapy and thereby safety by avoiding behavior triggering AOA alarms and disturbing their fellow patients and the health care professionals. Adherence, defined as patients’ consistency in taking their medications as prescribed, becomes an important point of attention for health professionals when applying individualized robotic therapies such as AOA to patients with COPD. To support patients in the process of managing adherence to therapeutic technology, we propose a person-centered care approach that, through education and communication with the patients, generates an understanding of how they can self-manage AOA and its alarms without activating avoiding behavior that threatens their treatment and recovery.

https://doi.org/10.1080/15412555.2022.2141620

Patients’ Perspective on Automated Oxygen Administration during Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Qualitative Study Nested in a Randomized Controlled Trial

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. 

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

Background: When treating acute respiratory failure, both hypoxemia and hyperoxemia should be avoided. SpO2 should be monitored closely and O2 flows adjusted accordingly. Achieving this goal might be easier with automated O2 titration compared to manual titration of fixed-flow O2 We evaluated the feasibility of using an automated O2 titration device in subjects treated for acute hypoxemic respiratory failure in a tertiary care hospital.Methods: Healthcare workers received education and training about oxygen therapy and were familiarized with an automated O2 titration device (FreeO2, Oxynov, Quebec City, Canada). A coordinator was available from 8 am to 5 pm during week days to provide technical assistance. The ability of the device to maintain SpO2 within the prescribed therapeutic window was recorded. Basic clinical information was recorded.Results: Subjects were enrolled from November 2020 to August 2022. We trained 508 healthcare workers on use of automated O2 titration which was finally used on 872 occasions in 763 subjects, distributed on the respiratory, COVID-19 and thoracic surgery wards and the emergency room. Clinical information could be retrieved for 609 (80%) subjects who were on the system for a median of 3 days (interquartile range: 2 to 6 days) representing 2567 subject-days of clinical experience with the device. In the 82 (14%) subjects for whom this information was available, the system maintained SpO2 within the prescribed targets 89% of the time. Ninety-six subjects experienced clinical deterioration as defined by the need to be transferred to the intensive care unit and/or requirement of high nasal flow oxygen but none of these events were judged to be related to the O2 device.Conclusions: Automated O2 titration could be successfully implemented in hospitalized subjects with hypoxemic respiratory failure from various causes. This experience should foster further improvement of the device and recommendations for an optimized utilization.

Clinical implementation of automated O2 titration in a tertiary care hospital.

Background Oxygen is critical to the prevention of hypoxemia-induced morbidity and mortality; yet, access remains inadequate in most low- and middle-income countries despite billions of dollars spent over decades to increase supply. We present a new method for supplemental oxygen delivery whereby the OXFO System (OXFO Corporation, Boston, MA, USA) converts pressurized oxygen to ambient pressure for patient inhalation on demand at a fixed concentration across fluctuations in respiratory rate or tidal volume. This study’s primary aims were to examine the oxygen volume savings and test the non-inferiority of mean peripheral oxygen saturation (S pO2 ) with the OXFO System (OXFO Condition) compared to conventional continuous flow (Standard Condition) in a clinical population of oxygen-dependent hospitalized adults. Methods We conducted a non-inferiority, single-visit, randomized, crossover design. A total of 20 subjects were randomized to receive either OXFO Condition or Standard Condition first. Subjects were administered oxygen for 20 minutes during each condition after oxygen was titrated to target therapeutic S pO2 . A one-sample t-test was performed to compare the mean ratio of oxygen volume dispensed (OXFO Condition/Standard Condition) with 100%. A paired t-test for non-inferiority was used to test the hypothesis that the mean S pO2 for OXFO Condition is no worse than 2.8% lower (absolute difference) than the mean S pO2 for Standard Condition. Results Nineteen subjects were included in the analyses. When considering the dispensing of oxygen as a ratio (OXFO Condition / Standard Condition) for each subject, the mean was 7.7% (standard deviation(SD)=5.4%; range=0-20%) and this was significantly different from 100% ( P &lt;0.001). The savings ratio was not significantly correlated with Standard Condition rate of flow ( P =0.23). Mean S pO2 for OXFO Condition was 91.07% (SD=2.20%) and 91.35% (SD=1.62%) for Standard Condition and the difference was significantly above the non-inferiority margin of -2.80% ( P &lt;0.001). Conclusions The OXFO System saves a significant volume of oxygen while achieving non-inferior mean saturation for hospitalized oxygen-dependent patients. The OXFO System appears to maintain robust volume savings of nearly 13x across doses up to 6 liters per minute (L/min). This has significant implications for advancing equitable access to oxygen. 

A novel device for conservation of supplemental oxygen: A randomized, crossover study of the efficiency and non-inferiority of the OXFO System

Purpose of the study To evaluate documentation of a target oxygen saturation (SpO2) range and ability to achieve this range in acutely unwell inpatients. Study design In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO2 range, the proportion of SpO2 measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO2. Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration. Results 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO2 range was documented in 62. The mean (SD) proportion of SpO2 measurements within range was 56.2 (30.6)%. A hypercapnic target SpO2 range was associated with a higher probability of an SpO2 above range; multivariate OR 5.34 (95% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO2 below range; multivariate OR 0.25 (95% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO2 was similar in those with a target range of 92%–96% versus a hypercapnic range; 96.2 (3.0)% and 95.2 (3.4)%, respectively. Conclusions Oxygen prescription and delivery in this clinical setting was suboptimal. SpO2 values above the designated range are common, particularly in patients with a hypercapnic target range.

https://pmj.bmj.com/content/postgradmedj/early/2021/02/15/postgradmedj-2020-139511.full.pdf

Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Robert McLachlan

Author Tools

Chat about Author

Papers

Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients.