A quasi-experimental study of targeted normoxia in critically ill trauma patients

• Published in: The journal of trauma and acute care surgery
• Main Authors: Dylla, Layne, Anderson, Erin L, Douin, David J, Jackson, Conner L, Rice, John D, Schauer, Maj Steven G, Neumann, Robert T, Bebarta, Col Vikhyat S, Wright, Franklin L, Ginde, Adit A
• Format: Journal Article
• Language: English
• Published: United States 23.03.2021
• ISSN: 2163-0763

Avoidance of hypoxia and hyperoxia may reduce morbidity and mortality in critically ill civilian and military trauma patients. The objective of this study is to determine if a multimodal quality improvement intervention increases adherence to a consensus-based, targeted normoxia strategy. We hypothesized that this intervention would safely improve compliance with targeted normoxia. This is a pre/post quasi-experimental pilot study to improve adherence to normoxia, defined as a pulse oximetry (SpO2) of 90-96% or an arterial partial pressure oxygen (PaO2) of 60-100mmHg. We used a multimodal informatics and educational intervention guiding clinicians to safely titrate supplemental oxygen to normoxia based on SpO2 monitoring in critically ill trauma patients admitted to the surgical-trauma or neurosurgical intensive care unit within 24 hours of emergency department arrival. The primary outcome was effectiveness in delivering targeted normoxia (i.e., an increase in the probability of being in the targeted normoxia range and/or a reduction in the probability of being on a higher FiO2). Analysis included 371 pre-intervention subjects and 201 post-intervention subjects. Pre-and post-intervention subjects were of similar age, race/ethnicity, and gender and had similar comorbidities and APACHE II scores. Overall, the adjusted probability of being hyperoxic while on supplemental oxygen was reduced during the post-intervention period (adjusted odds ratio (aOR) 0.74, 95% confidence interval (CI) 0.57-0.97). There was a higher probability of being on room air (fraction inspired oxygen concentration (FiO2)=0.21) in the post-intervention period (aOR 1.38, 95%CI 0.83-2.30). Additionally, there was a decreased amount of patient time spent on higher levels of FiO2 (FiO2 >40%) without a concomitant increase in hypoxia. A multimodal intervention targeting normoxia in critically ill trauma patients increased normoxia and lowered the use of supplemental oxygen. A large clinical trial is needed to validate the impact of this protocol on patient-centered clinical outcomes. Therapeutic/Care Management, level II.