PMID- 31145642
OWN - NLM
STAT- MEDLINE
DCOM- 20200930
LR  - 20200930
IS  - 2325-6621 (Electronic)
IS  - 2325-6621 (Linking)
VI  - 16
IP  - 9
DP  - 2019 Sep
TI  - The "Just Right" Amount of Oxygen. Improving Oxygen Use in a Rwandan Emergency 
      Department.
PG  - 1138-1142
LID - 10.1513/AnnalsATS.201811-763QI [doi]
AB  - Rationale: Despite oxygen's classification as an essential medication by the 
      World Health Organization, it is inconsistently available in many 
      resource-constrained settings. Hypoxemia is associated with increased mortality, 
      and mounting evidence suggests that hyperoxia may also be associated with adverse 
      outcomes.Objectives: To determine if overuse of oxygen for some patients in a 
      Rwandan tertiary care hospital emergency department might coexist with oxygen 
      shortages and underuse of oxygen for other patients, and whether an educational 
      intervention coupled with provision of pulse oximeters could improve the 
      distribution of limited oxygen resources.Methods: We screened all patients in the 
      adult emergency department (ED) of the University Teaching Hospital of Kigali for 
      hypoxemia and receipt of oxygen therapy for 5 weeks. After completing baseline 
      data collection, we provided pulse oximeters and conducted a didactic training 
      with pre- and posttests on oxygen titration, with a chosen target oxygen 
      saturation (Sp(O(2))) of 90% to 95%. Four and 12 weeks after the intervention, we 
      evaluated all patients in the ED again for Sp(O(2)) and receipt of oxygen therapy 
      for 4 weeks each period. We also recorded ED oxygen use and availability of 
      reserve oxygen for the hospital during the three study periods.Results: During 
      all data collection periods, 214 of 1,765 (12.1%) unique patients screened were 
      hypoxemic. The proportion of patient-days with appropriately titrated oxygen 
      therapy (Sp(O(2)), 90-95%) increased from 18.7% at baseline to 38.5% and 42.0% at 
      4 and 12 weeks postintervention (P < 0.001). On a multiple-choice examination 
      testing knowledge of appropriate oxygen titration, clinicians' scores improved 
      from average 60% (interquartile range [IQR], 40-80%) correct to 80% (IQR, 60-80%) 
      correct immediately after the educational intervention (P < 0.001). Oxygen use in 
      the ED decreased from a median of 32.0 (IQR, 28.0-35.0) tanks per day to 25.5 
      (IQR, 24.0-29.0) and 16.0 (IQR, 12.5-21.0) tanks per day at Weeks 4 and 12, 
      respectively (P < 0.001), and the median daily number of tanks in reserve for the 
      hospital appeared to increase, although this did not reach statistical 
      significance (30.0 [IQR, 9.0-46.0], 86.5 [IQR, 74.0-92.0], and 75.5 [IQR, 
      8.5-88.5], respectively; P = 0.07).Conclusions: Among patients in a Rwandan adult 
      ED, 12.1% of patients were hypoxemic and 81.3% of patient-days were either under- 
      or overtreated with oxygen during baseline data collection on the basis of our 
      defined target of Sp(O(2)) 90% to 95%. Follow-up results at 4 and 12 weeks 
      postintervention demonstrated sustained improvement in oxygen titration and 
      likely increased availability of oxygen resources.
FAU - Sutherland, Tori
AU  - Sutherland T
AUID- ORCID: 0000-0003-3593-237X
AD  - Department of Anesthesiology, Critical Care, and Pain Medicine and.
FAU - Moriau, Victor
AU  - Moriau V
AD  - Department of Emergency Medicine, Universite Libre de Bruxelles, Faculte de 
      Medecine, Brussels, Belgium; and.
FAU - Niyonzima, Joseph M
AU  - Niyonzima JM
AD  - Department of Emergency Medicine and.
FAU - Mueller, Ariel
AU  - Mueller A
AD  - Department of Anesthesiology, Critical Care, and Pain Medicine and.
FAU - Kabeja, Lise
AU  - Kabeja L
AD  - Department of Emergency Medicine and.
FAU - Twagirumugabe, Theogene
AU  - Twagirumugabe T
AD  - Department of Anesthesiology, Kigali University Teaching Hospital, University of 
      Rwanda, College of Medicine and Health Sciences, School of Medicine and Pharmacy, 
      Kigali, Rwanda.
FAU - Rosenberg, Noah
AU  - Rosenberg N
AD  - Department of Emergency Medicine and.
FAU - Umuhire, Olivier F
AU  - Umuhire OF
AD  - Department of Emergency Medicine and.
FAU - Talmor, Daniel S
AU  - Talmor DS
AD  - Department of Anesthesiology, Critical Care, and Pain Medicine and.
FAU - Riviello, Elisabeth D
AU  - Riviello ED
AD  - Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess 
      Medical Center, Harvard Medical School, Boston, Massachusetts.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Am Thorac Soc
JT  - Annals of the American Thoracic Society
JID - 101600811
RN  - S88TT14065 (Oxygen)
SB  - IM
CIN - Ann Am Thorac Soc. 2019 Sep;16(9):1116-1117. PMID: 31469309
MH  - Adult
MH  - Aged
MH  - Blood Gas Analysis
MH  - Developing Countries
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Hospitals, University
MH  - Humans
MH  - Hyperoxia/blood/*therapy
MH  - Hypoxia/blood/*therapy
MH  - Male
MH  - Middle Aged
MH  - Oximetry
MH  - Oxygen/*blood
MH  - Oxygen Inhalation Therapy/*standards
MH  - Quality Improvement/organization & administration
MH  - Rwanda
OTO - NOTNLM
OT  - hyperoxia
OT  - hypoxemia
OT  - low-income country
OT  - quality improvement
OT  - resource poor settings
EDAT- 2019/05/31 06:00
MHDA- 2020/10/02 06:00
CRDT- 2019/05/31 06:00
PHST- 2019/05/31 06:00 [pubmed]
PHST- 2020/10/02 06:00 [medline]
PHST- 2019/05/31 06:00 [entrez]
AID - 10.1513/AnnalsATS.201811-763QI [doi]
PST - ppublish
SO  - Ann Am Thorac Soc. 2019 Sep;16(9):1138-1142. doi: 10.1513/AnnalsATS.201811-763QI.