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\n\n \n \n \n \n \n \n Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients.\n \n \n \n \n\n\n \n Harper, J.; Kearns, N.; Bird, G.; McLachlan, R.; Eathorne, A.; Weatherall, M.; and Beasley, R.\n\n\n \n\n\n\n
Postgraduate Medical Journal,postgradmedj–2020–139511. February 2021.\n
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@article{harper_audit_2021,\n\ttitle = {Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients},\n\tissn = {0032-5473, 1469-0756},\n\turl = {https://pmj.bmj.com/lookup/doi/10.1136/postgradmedj-2020-139511},\n\tdoi = {10.1136/postgradmedj-2020-139511},\n\tabstract = {Purpose of the study\n \n To evaluate documentation of a target oxygen saturation (SpO\n 2\n ) range and ability to achieve this range in acutely unwell inpatients.\n \n \n \n Study design\n \n In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO\n 2\n range, the proportion of SpO\n 2\n measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO\n 2\n . Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration.\n \n \n \n Results\n \n 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO\n 2\n range was documented in 62. The mean (SD) proportion of SpO\n 2\n measurements within range was 56.2 (30.6)\\%. A hypercapnic target SpO\n 2\n range was associated with a higher probability of an SpO\n 2\n above range; multivariate OR 5.34 (95\\% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO\n 2\n below range; multivariate OR 0.25 (95\\% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO\n 2\n was similar in those with a target range of 92\\%–96\\% versus a hypercapnic range; 96.2 (3.0)\\% and 95.2 (3.4)\\%, respectively.\n \n \n \n Conclusions\n \n Oxygen prescription and delivery in this clinical setting was suboptimal. SpO\n 2\n values above the designated range are common, particularly in patients with a hypercapnic target range.},\n\tlanguage = {en},\n\turldate = {2022-03-04},\n\tjournal = {Postgraduate Medical Journal},\n\tauthor = {Harper, James and Kearns, Nethmi and Bird, Grace and McLachlan, Robert and Eathorne, Allie and Weatherall, Mark and Beasley, Richard},\n\tmonth = feb,\n\tyear = {2021},\n\tpages = {postgradmedj--2020--139511},\n}\n\n
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\n Purpose of the study To evaluate documentation of a target oxygen saturation (SpO 2 ) range and ability to achieve this range in acutely unwell inpatients. Study design In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO 2 range, the proportion of SpO 2 measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO 2 . Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration. Results 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO 2 range was documented in 62. The mean (SD) proportion of SpO 2 measurements within range was 56.2 (30.6)%. A hypercapnic target SpO 2 range was associated with a higher probability of an SpO 2 above range; multivariate OR 5.34 (95% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO 2 below range; multivariate OR 0.25 (95% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO 2 was similar in those with a target range of 92%–96% versus a hypercapnic range; 96.2 (3.0)% and 95.2 (3.4)%, respectively. Conclusions Oxygen prescription and delivery in this clinical setting was suboptimal. SpO 2 values above the designated range are common, particularly in patients with a hypercapnic target range.\n
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\n\n \n \n \n \n \n \n Determination of oxygen saturation compared to a prescribed target range using continuous pulse oximetry in acutely unwell medical patients.\n \n \n \n \n\n\n \n Harper, J. C. P.; Semprini, R.; Kearns, N. A.; Hatter, L.; Bird, G. E.; Braithwaite, I.; Eathorne, A.; Weatherall, M.; and Beasley, R.\n\n\n \n\n\n\n
BMC Pulmonary Medicine, 21(1): 332. December 2021.\n
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@article{harper_determination_2021,\n\ttitle = {Determination of oxygen saturation compared to a prescribed target range using continuous pulse oximetry in acutely unwell medical patients},\n\tvolume = {21},\n\tissn = {1471-2466},\n\turl = {https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01700-6},\n\tdoi = {10.1186/s12890-021-01700-6},\n\tabstract = {Abstract\n \n Background\n \n Both inadequate and excessive administration of oxygen to acutely unwell patients results in risk of harm. Guidelines recommend titration of oxygen to achieve a target oxygen saturation (SpO\n 2\n ) range. Information regarding whether this is being achieved is limited.\n \n \n \n Methods\n \n In this two-centre non-interventional study we used continuous pulse oximetry in acutely unwell medical patients over a 24-h period to determine the proportion of time spent with SpO\n 2\n within the prescribed target range and whether this is influenced by the target range, age, care in a high-dependency area and the number of oxygen adjustments.\n \n \n \n Results\n \n Eighty participants were included in the analysis. The mean (SD) proportion of time spent in target range was 55.6\\% (23.6), this was lower in those with a reduced hypercapnic target range (88–92\\% or below) compared to those with a range of 92–96\\%; difference − 13.1\\% (95\\% CI − 3.0 to − 23.2),\n P\n = 0.012. The proportion of time spent above range was 16.2\\% (22.9); this was higher in those with a reduced hypercapnic range; difference 21.6\\% (31.4 to 12),\n P\n {\\textless} 0.001. The proportion of time below range was 28.4\\% (25.2); there was no difference between target ranges. The proportion of time spent in range was higher for those in a high dependency area in the multivariate model; difference 15.5\\% (95\\% CI 2.3 to 28.7),\n P\n = 0.02.\n \n \n \n Conclusions\n \n Medical patients receiving oxygen in a ward setting spend significant periods of time with SpO\n 2\n both above and below the prescribed target range while receiving oxygen therapy.},\n\tlanguage = {en},\n\tnumber = {1},\n\turldate = {2022-03-04},\n\tjournal = {BMC Pulmonary Medicine},\n\tauthor = {Harper, James C. P. and Semprini, Ruth and Kearns, Nethmi A. and Hatter, Lee and Bird, Grace E. and Braithwaite, Irene and Eathorne, Allie and Weatherall, Mark and Beasley, Richard},\n\tmonth = dec,\n\tyear = {2021},\n\tpages = {332},\n}\n\n
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\n Abstract Background Both inadequate and excessive administration of oxygen to acutely unwell patients results in risk of harm. Guidelines recommend titration of oxygen to achieve a target oxygen saturation (SpO 2 ) range. Information regarding whether this is being achieved is limited. Methods In this two-centre non-interventional study we used continuous pulse oximetry in acutely unwell medical patients over a 24-h period to determine the proportion of time spent with SpO 2 within the prescribed target range and whether this is influenced by the target range, age, care in a high-dependency area and the number of oxygen adjustments. Results Eighty participants were included in the analysis. The mean (SD) proportion of time spent in target range was 55.6% (23.6), this was lower in those with a reduced hypercapnic target range (88–92% or below) compared to those with a range of 92–96%; difference − 13.1% (95% CI − 3.0 to − 23.2), P = 0.012. The proportion of time spent above range was 16.2% (22.9); this was higher in those with a reduced hypercapnic range; difference 21.6% (31.4 to 12), P \\textless 0.001. The proportion of time below range was 28.4% (25.2); there was no difference between target ranges. The proportion of time spent in range was higher for those in a high dependency area in the multivariate model; difference 15.5% (95% CI 2.3 to 28.7), P = 0.02. Conclusions Medical patients receiving oxygen in a ward setting spend significant periods of time with SpO 2 both above and below the prescribed target range while receiving oxygen therapy.\n
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\n\n \n \n \n \n \n \n Automatic versus manual oxygen titration using a novel nasal high-flow device in medical inpatients with an acute illness: a randomised controlled trial.\n \n \n \n \n\n\n \n Harper, J.; Kearns, N.; Bird, G.; Braithwaite, I.; Eathorne, A.; Shortt, N.; Weatherall, M.; and Beasley, R.\n\n\n \n\n\n\n
BMJ Open Respiratory Research, 8(1): e000843. August 2021.\n
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@article{harper_automatic_2021,\n\ttitle = {Automatic versus manual oxygen titration using a novel nasal high-flow device in medical inpatients with an acute illness: a randomised controlled trial},\n\tvolume = {8},\n\tissn = {2052-4439},\n\tshorttitle = {Automatic versus manual oxygen titration using a novel nasal high-flow device in medical inpatients with an acute illness},\n\turl = {https://bmjopenrespres.bmj.com/lookup/doi/10.1136/bmjresp-2020-000843},\n\tdoi = {10.1136/bmjresp-2020-000843},\n\tabstract = {Background\n \n Guideline recommendations state oxygen should be administered to acutely unwell patients to achieve a target oxygen saturation (SpO\n 2\n ) range. The current practice of manual oxygen titration frequently results in SpO\n 2\n outside of a prescribed range. The aim of this study was to assess the efficacy of automatic oxygen titration using a closed-loop feedback system to achieve SpO\n 2\n within a prescribed target range\n \n \n \n Methods\n \n An open-label randomised parallel group trial was undertaken comparing automatic oxygen titration using a novel nasal high-flow device to manual oxygen titration using nasal high flow. Medical inpatients requiring oxygen therapy in Wellington Regional Hospital, New Zealand with a prescribed target SpO\n 2\n range of 88\\%–92\\% or 92\\%–96\\% were recruited and randomised equally between the interventions for a period of 24 hours. The primary outcome was the proportion of time spent with SpO\n 2\n within the prescribed range.\n \n \n \n Results\n \n 20 patients were included in the analysis. Automatic oxygen titration resulted in a median (IQR) 96.2\\% (95.2–97.8) of time within the target range compared with 71\\% (59.4–88.3) with manual titration; difference (95\\% CI) 24.2\\% (7.9\\% to 35\\%), p{\\textless}0.001. There was a reduction in the time spent with SpO\n 2\n ≥2\\% above and ≥2\\% below range in the automatic titration group, although the point estimate for the differences were small; −1\\% (−8.2\\% to −0.04\\%), p=0.017 and −2.4\\% (−11.5\\% to 0.3\\%), p=0.05 respectively.\n \n \n \n Conclusions\n \n Nasal high-flow with automatic oxygen titration resulted in a greater proportion of time spent with SpO\n 2\n in target range compared with manual titration.\n \n \n \n Trial registration\n The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000901101).},\n\tlanguage = {en},\n\tnumber = {1},\n\turldate = {2021-10-02},\n\tjournal = {BMJ Open Respiratory Research},\n\tauthor = {Harper, James and Kearns, Nethmi and Bird, Grace and Braithwaite, Irene and Eathorne, Allie and Shortt, Nicholas and Weatherall, Mark and Beasley, Richard},\n\tmonth = aug,\n\tyear = {2021},\n\tpages = {e000843},\n}\n\n
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\n Background Guideline recommendations state oxygen should be administered to acutely unwell patients to achieve a target oxygen saturation (SpO 2 ) range. The current practice of manual oxygen titration frequently results in SpO 2 outside of a prescribed range. The aim of this study was to assess the efficacy of automatic oxygen titration using a closed-loop feedback system to achieve SpO 2 within a prescribed target range Methods An open-label randomised parallel group trial was undertaken comparing automatic oxygen titration using a novel nasal high-flow device to manual oxygen titration using nasal high flow. Medical inpatients requiring oxygen therapy in Wellington Regional Hospital, New Zealand with a prescribed target SpO 2 range of 88%–92% or 92%–96% were recruited and randomised equally between the interventions for a period of 24 hours. The primary outcome was the proportion of time spent with SpO 2 within the prescribed range. Results 20 patients were included in the analysis. Automatic oxygen titration resulted in a median (IQR) 96.2% (95.2–97.8) of time within the target range compared with 71% (59.4–88.3) with manual titration; difference (95% CI) 24.2% (7.9% to 35%), p\\textless0.001. There was a reduction in the time spent with SpO 2 ≥2% above and ≥2% below range in the automatic titration group, although the point estimate for the differences were small; −1% (−8.2% to −0.04%), p=0.017 and −2.4% (−11.5% to 0.3%), p=0.05 respectively. Conclusions Nasal high-flow with automatic oxygen titration resulted in a greater proportion of time spent with SpO 2 in target range compared with manual titration. Trial registration The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000901101).\n
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\n\n \n \n \n \n \n \n Closed-Loop Oxygen Control Using a Novel Nasal High-Flow Device: A Randomized Crossover Trial.\n \n \n \n \n\n\n \n Harper, J. C.; Kearns, N. A; Maijers, I.; Bird, G. E; Braithwaite, I.; Shortt, N. P; Eathorne, A.; Weatherall, M.; and Beasley, R.\n\n\n \n\n\n\n
Respiratory Care, 66(3): 416–424. March 2021.\n
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@article{harper_closed-loop_2021,\n\ttitle = {Closed-{Loop} {Oxygen} {Control} {Using} a {Novel} {Nasal} {High}-{Flow} {Device}: {A} {Randomized} {Crossover} {Trial}},\n\tvolume = {66},\n\tissn = {0020-1324, 1943-3654},\n\tshorttitle = {Closed-{Loop} {Oxygen} {Control} {Using} a {Novel} {Nasal} {High}-{Flow} {Device}},\n\turl = {http://rc.rcjournal.com/lookup/doi/10.4187/respcare.08087},\n\tdoi = {10.4187/respcare.08087},\n\tlanguage = {en},\n\tnumber = {3},\n\turldate = {2021-04-28},\n\tjournal = {Respiratory Care},\n\tauthor = {Harper, James CP and Kearns, Nethmi A and Maijers, Ingrid and Bird, Grace E and Braithwaite, Irene and Shortt, Nicholas P and Eathorne, Allie and Weatherall, Mark and Beasley, Richard},\n\tmonth = mar,\n\tyear = {2021},\n\tpages = {416--424},\n}\n\n
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\n\n \n \n \n \n \n \n Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients.\n \n \n \n \n\n\n \n Harper, J.; Kearns, N.; Bird, G.; McLachlan, R.; Eathorne, A.; Weatherall, M.; and Beasley, R.\n\n\n \n\n\n\n
Postgraduate Medical Journal,postgradmedj–2020–139511. February 2021.\n
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\n\n \n \n Paper\n \n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 2 downloads\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n
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@article{harper_audit_2021-1,\n\ttitle = {Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients},\n\tissn = {0032-5473, 1469-0756},\n\turl = {https://pmj.bmj.com/lookup/doi/10.1136/postgradmedj-2020-139511},\n\tdoi = {10.1136/postgradmedj-2020-139511},\n\tabstract = {Purpose of the study\n \n To evaluate documentation of a target oxygen saturation (SpO\n 2\n ) range and ability to achieve this range in acutely unwell inpatients.\n \n \n \n Study design\n \n In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO\n 2\n range, the proportion of SpO\n 2\n measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO\n 2\n . Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration.\n \n \n \n Results\n \n 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO\n 2\n range was documented in 62. The mean (SD) proportion of SpO\n 2\n measurements within range was 56.2 (30.6)\\%. A hypercapnic target SpO\n 2\n range was associated with a higher probability of an SpO\n 2\n above range; multivariate OR 5.34 (95\\% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO\n 2\n below range; multivariate OR 0.25 (95\\% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO\n 2\n was similar in those with a target range of 92\\%–96\\% versus a hypercapnic range; 96.2 (3.0)\\% and 95.2 (3.4)\\%, respectively.\n \n \n \n Conclusions\n \n Oxygen prescription and delivery in this clinical setting was suboptimal. SpO\n 2\n values above the designated range are common, particularly in patients with a hypercapnic target range.},\n\tlanguage = {en},\n\turldate = {2021-04-28},\n\tjournal = {Postgraduate Medical Journal},\n\tauthor = {Harper, James and Kearns, Nethmi and Bird, Grace and McLachlan, Robert and Eathorne, Allie and Weatherall, Mark and Beasley, Richard},\n\tmonth = feb,\n\tyear = {2021},\n\tpages = {postgradmedj--2020--139511},\n}\n\n
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\n Purpose of the study To evaluate documentation of a target oxygen saturation (SpO 2 ) range and ability to achieve this range in acutely unwell inpatients. Study design In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO 2 range, the proportion of SpO 2 measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO 2 . Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration. Results 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO 2 range was documented in 62. The mean (SD) proportion of SpO 2 measurements within range was 56.2 (30.6)%. A hypercapnic target SpO 2 range was associated with a higher probability of an SpO 2 above range; multivariate OR 5.34 (95% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO 2 below range; multivariate OR 0.25 (95% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO 2 was similar in those with a target range of 92%–96% versus a hypercapnic range; 96.2 (3.0)% and 95.2 (3.4)%, respectively. Conclusions Oxygen prescription and delivery in this clinical setting was suboptimal. SpO 2 values above the designated range are common, particularly in patients with a hypercapnic target range.\n
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\n\n \n \n \n \n \n \n Is less really more for oxygen therapy in patients with acute respiratory failure?.\n \n \n \n \n\n\n \n Young, P. J.; Gladwin, B.; and Capdevila, M.\n\n\n \n\n\n\n
Anaesthesia Critical Care & Pain Medicine, 40(2): 100858. April 2021.\n
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@article{young_is_2021,\n\ttitle = {Is less really more for oxygen therapy in patients with acute respiratory failure?},\n\tvolume = {40},\n\tissn = {23525568},\n\turl = {https://linkinghub.elsevier.com/retrieve/pii/S2352556821000618},\n\tdoi = {10.1016/j.accpm.2021.100858},\n\tlanguage = {en},\n\tnumber = {2},\n\turldate = {2021-04-28},\n\tjournal = {Anaesthesia Critical Care \\& Pain Medicine},\n\tauthor = {Young, Paul J. and Gladwin, Benjamin and Capdevila, Mathieu},\n\tmonth = apr,\n\tyear = {2021},\n\tpages = {100858},\n}\n\n
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\n\n \n \n \n \n \n Effect of Oxygen Therapy on Mortality in the ICU.\n \n \n \n\n\n \n Young, P. J.\n\n\n \n\n\n\n
The New England Journal of Medicine, 384(14): 1361–1363. April 2021.\n
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@article{young_effect_2021,\n\ttitle = {Effect of {Oxygen} {Therapy} on {Mortality} in the {ICU}},\n\tvolume = {384},\n\tissn = {1533-4406},\n\tdoi = {10.1056/NEJMe2101538},\n\tlanguage = {eng},\n\tnumber = {14},\n\tjournal = {The New England Journal of Medicine},\n\tauthor = {Young, Paul J.},\n\tmonth = apr,\n\tyear = {2021},\n\tpmid = {33826824},\n\tkeywords = {Humans, Intensive Care Units, Oxygen, Oxygen Inhalation Therapy, Respiratory Insufficiency},\n\tpages = {1361--1363},\n}\n\n
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\n\n \n \n \n \n \n \n Searching for the optimal oxygen saturation range in acutely unwell patients.\n \n \n \n \n\n\n \n Pilcher, J. M.; Kearns, C.; and Beasley, R.\n\n\n \n\n\n\n
Emergency Medicine Journal, 38(3): 168–169. March 2021.\n
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@article{pilcher_searching_2021,\n\ttitle = {Searching for the optimal oxygen saturation range in acutely unwell patients},\n\tvolume = {38},\n\tissn = {1472-0205, 1472-0213},\n\turl = {https://emj.bmj.com/lookup/doi/10.1136/emermed-2020-210749},\n\tdoi = {10.1136/emermed-2020-210749},\n\tlanguage = {en},\n\tnumber = {3},\n\turldate = {2021-02-24},\n\tjournal = {Emergency Medicine Journal},\n\tauthor = {Pilcher, Janine Marie and Kearns, Ciléin and Beasley, Richard},\n\tmonth = mar,\n\tyear = {2021},\n\tpages = {168--169},\n}\n\n
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