What’s New in the Patient Safety World
March 2014
Another Strike Against Hyperoxia
In several of our prior columns on use of oxygen (see our Patient Safety Tips of the Week April 8, 2008 “Oxygen as a Medication” and January 27, 2009 “Oxygen Therapy: Everything You Wanted to Know and More!”) we have commented that in the past we often routinely gave oxygen to patients with myocardial infarction or stroke. But such use was more reflexive in nature and not evidence-based.
In our What’s New in the Patient Safety World
columns for July 2010 “Cochrane
Review: Oxygen in MI” and February
2012 “More
Evidence of Harm from Oxygen” we discussed the lack of evidence to
support the routine use of oxygen in the acute MI patient and the possible
deleterious effects in these and some other cardiac patients.
Now another new study (Rincon 2014) shows that hyperoxia was independently associated with in-hospital death as compared with either normoxia or hypoxia in ventilated stroke patients admitted to ICU’s. Their data underscore the need for studies of controlled reoxygenation in ventilated critically ill stroke populations. They recommend that, in the absence of results from clinical trials, unnecessary oxygen delivery should be avoided in ventilated stroke patients.
As we’ve recommended before, hospitals need to look at their existing protocols (and actual practices) for managing a variety of medical conditions where oxygen use may be considered. How many of you have standardized order sets that directly (or indirectly by poor use of checkboxes) encourage inappropriate use of oxygen in MI or stroke patients? Going back to our Patient Safety Tips of the Week April 8, 2008 “Oxygen as a Medication” and January 27, 2009 “Oxygen Therapy: Everything You Wanted to Know and More!” we strongly support facilities doing audits of their oxygen practices. You’ll probably be surprised at the opportunities you uncover to improve practices (and save money at the same time!).
And don’t forget that in many cases high doses of oxygen are administered by the pre-hospital emergency response teams. Making them aware of the potential dangers is also important.
References:
Rincon F, Kang J, Maltenfort M, et al. Association Between Hyperoxia and Mortality After Stroke: A Multicenter Cohort Study. Critical Care Med 2014; 42(2): 387-396
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