Oxygenation targets, monitoring in the critically ill: a point prevalence study of clinical practice in Australia and New Zealand

Background: Many critically ill patients require supplemental oxygen. However, the optimal oxygen saturation measured by pulse oximetry (SpO2) in intensive care unit patients is unknown. Objective: To evaluate clinical practice in Australia and New Zealand ICUs in relation to SpO2 monitoring, prescription of SpO2 targets by doctors, and upper and lower limits of tolerance of high and low SpO2 levels by ICU bedside nurses. Method: Cross-sectional, observational study conducted on 2 days in 2013 involving adult patients in Australia and New Zealand ICUs. Results: Data from 350 adult ICU patients were included. SpO2 alarms were less likely to be disabled in patients who were invasively ventilated than in patients not receiving supplemental oxygen (4.8 v 15.1 ; P = 0.02). In mechanically ventilated patients and non-ventilated patients receiving supplemental oxygen, the lower prescribed SpO2 limit and the ICU bedside nurses? stated limits for action for low SpO2 levels were 92 (interquartile range, 90 ?94 ). Upper SpO2 limits were less frequently prescribed than lower SpO2 limits (4.9 [95 CI, 3.0 ?7.7 v 36.6 [95 CI, 31.7 ?41.7 ); P <0.01) and the observed SpO2 exceeded the prescribed upper limit on 10/17 occasions (59 ) when an upper limit was prescribed. Conclusion: Our findings suggest a relatively low level of vigilance in relation to prevention of high SpO2 compared with low SpO2 for adult patients in Australian and New Zealand ICUs.