Critical Illness, Disease Attributes, Pathologic Processes, Wounds and Injury
Conditions
Keywords
hypoxia, hyperoxia, trauma, burn, critical illness, supplemental oxygen, oxygenation, SpO2, PaO2, FiO2, normoxia, hypoxemia, normoxemia, hyperoxemia
Brief summary
The objective is to determine the effectiveness of a multimodal educational intervention to reduce supplemental oxygen use in critically injured patients. Investigators will also evaluate the safety and clinical effectiveness of the more targeted use of oxygen therapy.
Detailed description
Oxygen therapy has undisputed importance in the care of critically ill patients to prevent secondary complications related to hypoxemia. Although routine, the practice of excessive over-oxygenation may be harmful. An expert panel was convened and developed the strong consensus to target normoxemia at an oxygen saturation (SpO2) range of 90-96%, an arterial oxygen (PaO2) range of 60-100 mmHg (when applicable), and a fraction of inspired oxygen (FiO2) of 21% for mechanically ventilated patients or room air for nonmechanically ventilated patients. Specific Aim: The purpose of this study is to determine the effectiveness of a multimodal educational intervention to reduce supplemental oxygen use in critically injured patients. Investigators will also evaluate the safety and clinical effectiveness of the more targeted use of oxygen therapy. Hypotheses: Clinical efforts to through a multimodal educational intervention will: 1. Improve the proportion of time spent within target normoxemia thresholds (oxygen saturation \[SpO2\] 90-96% and/or arterial oxygen \[PaO2\] 60-100 mmHg \[when applicable\] 2. Limit use of excessive supplemental oxygen 3. Reduce exposure to hyperoxemia without a substantive increase in hypoxemic episodes or adverse effects
Interventions
Post-implementation of targeted normoxemia through oxygen titration for individual patients. Interventions for treatment of hypoxemia will follow usual local practice. Interventions for treatment of hyperoxemia (SpO2 \>96% or PaO2 \>100 mmHg) will involve down titration of FiO2 (or supplemental oxygen for non-mechanically ventilated patients) within a time frame based on local site preferences-typically in increments of no greater than 0.10 until goal oxygenation in the normoxemia range is achieved (including room air \[no supplemental oxygen\] for non-mechanically ventilated patients).
Sponsors
United States Department of Defense
University of Colorado, Denver
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
* Acutely injured patients who meet the criteria for entry into the state or national trauma registry * Admission to surgical/trauma ICU within 24 hours of hospital arrival
Exclusion criteria
* Age \<18 years * Prisoners * Known pregnancy * Transferred patients not admitted through the emergency department
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Supplemental Oxygen Free Days (SOFD) | up to 28 days | Number of days alive and not on supplemental oxygen during the index hospitalization (0 days \[worst outcome\] to 28 days \[best outcome\]) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| In-hospital Mortality to day 90 | up to 90 days | Dichotomous vital status (survived or died) at hospital discharge or day 90, whichever is first |
| Time to Mortality to day 90 | up to 90 days | Vital status and date of death censored at hospital discharge or day 90, whichever is first |
| Ventilator Free Day (VFD) to day 28 | up to 28 days | Ventilator Free Days = Days off ventilator (0 VFD \[worst outcome\] to 28 VFD \[best outcome\]) |
| Time to Room Air | up to 90 days | Duration of supplemental oxygen (FiO2 = 0.21 or room air) |
| Glasgow Outcome Score (GOS) | up to 90 days | Patient will be assessed at hospital discharge with one of the following five categories: Death, Persistent Vegetative State, Severe Disability, Moderate Disability, Low Disability |
| Discharge Disposition | up to 90 days | Defined as home (return to prior level of care) or facility (e.g., acute rehab, skilled nursing facility) |
| Amount of Supplemental Oxygen Administered | up to 90 days | Total estimated oxygen volume while in the ICU after hospital arrival |
| Hospital-Free Days to day 90 (HFD90) | up to 90 days | Number of days alive and outside the hospital (0 days \[worst outcome\] to 90 days \[best outcome\]) |
| Proportion of Participants Receiving High Levels of Supplemental Oxygen | up to 90 days | FiO2\>0.40 or \>4 liters per minute for \>2 hours while in the ICU \[excludes time in the operating room\] |
| Duration of Time receiving High Levels of Supplemental Oxygen | up to 90 days | FiO2\>0.40 or \>4 liters per minute while in the ICU |
| Duration of Time Receiving No Supplemental Oxygen | up to 90 days | FiO2 0.21 or room air while in the ICU |
| Incidence of Hypoxemic Event (SpO2<88%) | up to 28 days | SpO2 saturation below 88% while in the ICU |
| Duration of Hypoxemic Events (SpO2<88%) | up to 90 days | SpO2 saturation below 88% while in the ICU |
| incidence of Hyperoxemic Event (SpO2>96%) | up to 90 days | SpO2 saturation above 96% while in the ICU |
| Duration of Hyperoxemic Event (SpO2>96%) | up to 90 days | SpO2 saturation above 96% while in the ICU |
| Duration of Time on Normoxemia Protocol Target | up to 90 days | Defined as SpO2 90-96% or receiving no supplemental oxygen (FiO2 0.21 or room air) while in the ICU |
Countries
United States
Outcome results
None listed