Fractional oxygen during mechanical ventilation, is a life sustaining therapy in the intensive care unit , used for about a million patients annually. Oxygen therapy needs to be tightly balanced as both hypoxia and hyperoxia are harmful. Establishing precision in oxygenation has significant implications for improving patient outcomes, resource utilization and reducing iatrogenic harm to a vulnerable population. The investigators propose an approach using a oxygen titration protocol consisting of electronic health records based alerts to guide oxygen adjustment.
The investigators will conduct a prospective randomized, clinical trial in the Medical Intensive Care Unit at Ohio State University Medical Center. In the intervention arm, respiratory therapists' will conduct oxygen titration with the help of a novel, high fidelity, electronic health records based, protocol consisting of electronic alerts and decision support tool. Oxygen titration in the control arm will be done without alerts and will be per "current standard of care". Participants for this study will be identified and recruited from patients admitted to the Ohio State University, Wexner Medical Center and James Cancer Hospital, Medical Intensive Care Unit.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
300
When FiO2 remains =\>0.4 and SpO2 =\>94% for more than 45 minutes, an electronic health record based alert will be sent to respiratory therapists to titrate oxygen per decision support tool.
Ohio State University Medical Center
Columbus, Ohio, United States
Duration of Hyperoxemia
The degree of excess exposure will be recorded as percent FiO2 \>0.4 when saturation continued to remain above 94%. Primary outcome will be determined by the proportion of time the patient will be "exposed to excessive supplied oxygen" divided by the total time under mechanical ventilation.
Time frame: Duration of Mechanical Ventilation, an average of 10-14 days
Ventilator Free days
The number of days between successful weaning from mechanical ventilation and day 28 after study enrollment.
Time frame: 28 days
ICU length of stay
Duration of stay in the intensive care unit after patient enrollment
Time frame: days of ICU stay within hospitalization, average of 20-25 days
Duration of stay in the hospital after patient enrollment
Duration of stay in the hospital after patient enrollment
Time frame: Current Hospital Stay, upto 30 days
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