clinical ROUNDS

August 2010 
Volume 40  Number 8
Pages 21 - 23
  PDF Version Available!

In a multicenter cohort study, researchers studied 6,326 ICU patients being treated for cardiac arrest. Patients were divided into three groups based on first arterial blood gas values obtained in the ICU: * hyperoxia (PaO2 of 300 mm Hg or more) * hypoxia (PaO2 of less than 60 mm Hg or ratio of PaO2 to FiO2 less than 300) * normoxia (not classified as hypoxia or hyperoxia).Mortality was significantly higher in the hyperoxia group compared with the other two groups.Besides finding that hyperoxia was a significant predictor of inhospital mortality following cardiac arrest, researchers found that compared with normoxia, hyperoxia was associated with a lower likelihood of independent functional status among survivors.The role of supplemental oxygen following resuscitation is controversial. Lab testing has suggested that excessive oxygenation after return of spontaneous circulation may be harmful, possibly related to reperfusion injury early in resuscitation. This study provides clinical evidence that too much oxygen can worsen anoxic brain injury, reduce survival, and impair recovery among survivors.The study included data collected from 120 U.S. hospitals between 2001 and 2005. Patient inclusion criteria were age over 17, nontraumatic cardiac arrest, CPR within 24 hours of ICU admission, and arterial blood gas analysis performed within 24 hours of ICU admission.Kilgannon JH, Jones AE, Shapiro NI, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010;303(21):2165–2171.The Emergency Nurses Association's Institute for Quality, Safety, and Injury Prevention has released guidelines to facilitate patient transfers from emergency medical services to the ED and from the ED to long-term-care settings. The goal is to ensure that patient hand-offs or transfers provide accurate information about patient care and treatment, the patient's current condition, and any recent or anticipated changes.State

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