Oxygenation advisor recommends appropriate positive end expiratory pressure and FIO2 settings: retrospective validation study

• Published in: Journal of clinical monitoring and computing 2014-04, Vol.28 (2), p.203-210
• Main Authors: Banner, Michael J., Euliano, Neil R., Grooms, David, Daniel Martin, A., Al-Rawas, Nawar, Gabrielli, Andrea
• Format: Article
• Language: English
• Subjects: Anesthesiology; Blood Gas Analysis - methods; Breath Tests - methods; Critical Care Medicine; Female; Health Sciences; Humans; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Original Research; Oximetry - methods; Oxygen Inhalation Therapy - methods; Positive-Pressure Respiration - methods; Reproducibility of Results; Respiratory Insufficiency - prevention & control; Respiratory Insufficiency - therapy; Retrospective Studies; Sensitivity and Specificity; Statistics for Life Sciences; Therapy, Computer-Assisted - methods; Treatment Outcome
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-013-9518-6

A decision support, rule-based oxygenation advisor that provides guidance for setting positive end expiratory pressure (PEEP) and fractional inhaled oxygen concentration (FIO 2 ) for patients with respiratory failure is described. The target oxygenation goal is to achieve and maintain pulse oximeter oxygen saturation (SpO 2 ) ≥88 and ≤95 %, as posited by the Acute Respiratory Distress Syndrome Network, by recommending appropriate combinations of PEEP and FIO 2 . For patient safety, the oxygenation advisor monitors mean arterial blood pressure (MAP) to ensure it is ≥65 mmHg for hemodynamic stability and inspiratory plateau pressure (Pplt) so it is ≤30 cm H 2 O for lung protection. The purpose of this validation study was to compare attending physicians’ recommendations to those recommendations of the oxygenation advisor for setting PEEP and FIO 2 . Adults with respiratory failure (n = 117) receiving ventilatory support were studied. PEEP, FIO 2 , SpO 2 , MAP, and Pplt are input variables into the advisor. Recommendations to increase, maintain, or decrease PEEP and FIO 2 are the oxygenation advisor’s output variables. Physicians’ recommendations for setting PEEP and FIO 2 were recorded; the oxygenation advisor’s recommendations were also recorded for comparison. At all times, ventilator settings were based on recommendations from attending physicians. PEEP ranged from 2 to 22 cm H 2 O and FIO 2 ranged from 0.30 to 0.65. A total of 326 recommendations by the oxygenation advisor and attending physicians were made to increase, maintain, or decrease PEEP and FIO 2 . There was a very significant relationship ( p