Clinicians' attitudes towards supplemental oxygen for trauma patients - A survey.

Tobias Arleth, Josefine Baekgaard, Oscar Rosenkrantz, Stine T Zwisler, Mikkel Andersen, Iscander M Maissan, Wolf E Hautz, Philip Verdonck, Lars S Rasmussen, Jacob Steinmetz
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Abstract

Introduction: The Advanced Trauma Life Support guidelines (ATLS; 2018, 10th ed.) recommend an early and liberal supplemental oxygen for all severely injured trauma patients to prevent hypoxaemia. As of 2024, these guidelines remain the most current. This may lead to hyperoxaemia, which has been associated with increased mortality and respiratory complications. We aimed to investigate the attitudes among clinicians, defined as physicians and prehospital personnel, towards the use of supplemental oxygen in trauma cases.

Materials and methods: A European, web-based, cross-sectional survey was conducted consisting of 23 questions. The primary outcome was the question: "In your opinion, should all severely injured trauma patients always be given supplemental oxygen, regardless of arterial oxygen saturation measured by pulse oximetry?".

Results: The survey was answered by 707 respondents, which corresponded to a response rate of 52 %. The respondents were predominantly male (76 %), with the largest representation from Denmark (82 %), and primarily educated as physicians (62 %). A majority of respondents (73 % [95 % CI: 70 to 76 %]) did not support that supplemental oxygen should always be provided to all severely injured trauma patients without consideration of their arterial oxygen saturation as measured by pulse oximetry (SpO2), with no significant difference between physicians and non-physicians (p = 0.08). Based on the respondents' preferred dosages, the median initial administered dosage of supplemental oxygen for spontaneously breathing trauma patients with a normal SpO2 in the first few hours after trauma was 0 (interquartile range [IQR] 0-3) litres per minute, with 58 % of respondents opting not to provide any supplemental oxygen. The lowest acceptable SpO2 goal in the first few hours after trauma was 94 % (IQR 92-95). In clinical scenarios with TBI, higher dosage of supplemental oxygen and fraction of inspired oxygen (FiO2) were preferred, as well as targeting partial pressure of oxygen in arterial blood as opposed to adjusting the FiO2 directly, compared to no TBI.

Conclusion: Almost three out of four clinicians did not support the administration of supplemental oxygen to all severely injured trauma patients, regardless of SpO2. This corresponds to a more restrictive approach than recommended in the current ATLS (2018, 10th ed.) guidelines.

临床医生对创伤患者补充氧气的态度 - 一项调查。
导言:高级创伤生命支持指南(ATLS;2018 年,第 10 版)建议对所有严重受伤的创伤患者进行早期和宽松的补氧,以预防低氧血症。截至 2024 年,这些指南仍然是最新的。这可能会导致高氧血症,而高氧血症与死亡率和呼吸系统并发症的增加有关。我们的目的是调查临床医生(指内科医生和院前工作人员)对在创伤病例中使用补充氧气的态度:我们在欧洲进行了一项基于网络的横断面调查,其中包括 23 个问题。主要结果是以下问题"结果:有 707 人回答了这一问题:共有 707 名受访者回答了这一问题,回答率为 52%。受访者以男性为主(76%),其中来自丹麦的受访者最多(82%),受教育程度以医生为主(62%)。大多数受访者(73% [95 % CI:70% 至 76%])不支持在不考虑脉搏氧饱和度(SpO2)测量动脉血氧饱和度的情况下为所有严重受伤的创伤患者提供补充氧气,医生和非医生之间没有显著差异(P = 0.08)。根据受访者的首选剂量,在创伤后最初几小时内SpO2正常的自主呼吸创伤患者的最初补充氧气用量中位数为每分钟0升(四分位数间距[IQR] 0-3),58%的受访者选择不提供任何补充氧气。外伤后数小时内可接受的最低 SpO2 目标为 94%(IQR 92-95)。在有创伤性脑损伤的临床情况下,与没有创伤性脑损伤相比,人们更倾向于使用更高的补充氧剂量和吸入氧分数(FiO2),以及以动脉血中的氧分压为目标,而不是直接调整 FiO2:结论:几乎四分之三的临床医生不支持对所有严重创伤患者进行补氧,无论其 SpO2 如何。这与现行的 ATLS(2018 年,第 10 版)指南所推荐的方法相比,限制性更大。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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