Intensive Care Clinicians’ Attitudes and Self-Reported Practice of Conservative Oxygen Therapy

Background: Conservative oxygen therapy (COT) targets a SpO2 of 90 - 92% using the lowest possible FiO2 for mechanically venti- lated (MV) adult patients. Conservative oxygen therapy aims to maintain adequate oxygenation while avoiding the harmful eects of hyperoxaemia. However, a lower SpO2 target during MV is recognised as challenging in current clinical norms. Objectives: We sought to describe intensive care clinicians' opinion and self-reported practice of conservative oxygen therapy. Methods: The research tool was a multi-choice questionnaire of intensive care clinicians working at 10 aliated metropolitan ter- tiary hospitals from January-April, 2014. Results: Four hundred and twelve (84%) sta members responded to the survey. Of these, 91% (375) were intensive care nurses and 9% (37) were medical doctors. A majority of respondents (86%, 356/412) considered oxygen-related lung injury as "Yes, a major concern". Most respondents, 85% (351/412), felt COT was easy to perform and a few respondents, 6% (23/412), considered performing COT to be stressful. More than 90% of the respondents reported not performing more arterial blood gases to monitor PaO2 during COT and essentially all (98%) indicated a desire to perform COT. Free text comments indicated COT as a challenge to current practice and expressed a strong desire to avoid inadvertent hypoxaemia. Conclusions: Intensive care clinicians varied in their opinion and self-reported practice of conservative oxygen therapy and were genuinely concerned about unintended physiological consequences related to targeting low SpO2 values. We recommend conser- vative oxygen therapy to be implemented cautiously in conjunction with further evaluation of its impact on outcomes for patients and the perceptions of clinicians.