The objective of this study is to conduct an observational pre/post study to evaluate the clinical impact oxygen guideline implementation on oxygen utilization and oxygenation in critically ill trauma patients.
Supplemental oxygen is fundamental in caring for critically ill trauma. While the avoidance of hypoxia is vital, the current clinical practice of excessive oxygenation settings is common, and unnecessary, and may even be harmful. An expert panel convened to define optimal oxygenation targets in critically ill trauma patients. The strong consensus was to target normoxia at an oxygen saturation (SpO2) range of 90-96% and arterial oxygen (PaO2) range of 60-100 mmHg. Accordingly, a pilot trial implementation of this consensus will occur for the care of trauma patients. Specific Aim: This is an observational pre/post study to evaluate the impact of targeted normoxia implementation in optimizing oxygen delivery and oxygenation in critically ill trauma patients. Hypotheses: That the clinical efforts to improve adherence to oxygen guidelines will: 1. improve the proportion of time spent with target normoxia thresholds (oxygen saturation SpO2 90-96%) by 2. reducing utilization of unnecessary supplementation oxygen 3. without a substantive increase in hypoxic episodes or an adverse impact on clinical outcomes.
Study Type
OBSERVATIONAL
Enrollment
572
The intervention (post-implementation) group will be trauma patients admitted to the ICU during the 6 months after the targeted normoxia implementation
The control (pre-implementation) group will be trauma patients admitted to the ICU during the 12 months prior to the targeted normoxia implementation
University of Colorado Hospital
Aurora, Colorado, United States
Patient-time Hyperoxic and Not on Room Air
Total percentage of patient-time hyperoxic and not on room air: total time spent by patients in a hyperoxic state while receiving supplemental oxygen, divided by total patient time on study
Time frame: From time of emergency department arrival until the date of hospital discharge or death, assessed up to 28 days from dates Jan. 1, 2018 to July 1, 2019
Episodes of Hypoxia (SpO2< 88%)
SpO2 saturations below 88%. Episodes of hypoxia reported in minutes (i.e. one episode of hypoxia = one minute spent).
Time frame: From time of emergency department arrival until the date of hospital discharge or death, assessed up to 28 days
Episodes of Hyperoxia (SpO2 >96%)
SpO2 saturations above 96%. Episodes of hyperoxia reported in minutes (i.e. one episode of hyperoxia = one minute spent).
Time frame: From time of emergency department arrival until the date of hospital discharge or death, assessed up to 28 days
Ventilator Free Day
Ventilator Free Days = Days off ventilator
Time frame: From time of emergency department arrival until the date of hospital discharge or death, assessed up to 28 days
Time to Room Air
Duration of supplemental oxygen use measured in days
Time frame: From time of emergency department arrival until the date of hospital discharge or death, assessed up to 28 days
Measured by Daily Sequential Organ Failure Assessment (SOFA)
Acute organ injury as measured by SOFA score
Time frame: First 7 days of hospitalization
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ICU Length of Stay
Number of days spent in the ICU
Time frame: From time of emergency department arrival until the date of ICU discharge or death, assessed up to 180 days
Hospital Length of Stay
Number of days spent in the hospital
Time frame: From time of emergency department arrival until the date of hospital discharge or death, assessed up to 180 days
Hospital Discharge Disposition
Percent of patients discharged to home or facility vs death or hospice = measuring illness at discharge
Time frame: Date of hospital discharge, assessed up to 180 days
Hospital Mortality
Percent of deceased participants
Time frame: From time of emergency department arrival until the date of hospital discharge or death, assessed up to 180 days