Investigation On The Current Situation Of Clinical Oxygen Therapy In A Comprehensive Hospital In Shanghai

Background:Oxygen therapy is a common and important treatment in clinical setting.It aims to improve and correct the hypoxaemia.However,if used improperly,oxygen therapy will also do harm to hospitalized patients.Many investigations abroad have shown that the administration in oxygen therapy may be sometimes sub-optimal in practice.This raises serious safety and effectiveness issues.In China,the current situation and prevalence of oxygen therapy is unknown.Guidelines or consensus at the national level have not yet been developed.Epidemiological investigations are also blank.Medicine personnel still lack enough attention to this widely used treatment.Objective:1.To evaluate the quality of clinical practice guidelines for oxygen therapy in the world,and select the theoretical guidance and gold standard of this study.2.To reveal the current characteristics of oxygen therapy in hospital,evaluate its rationality and standardization,and explore the comfort level of oxygen inhalation through nasal cannula as well as its possible influential factors.Methods:1.We searched Chinese-English literature databases and found out all the guidelines according with the purpose of this research.Then two respiratory specialists and a respiratory therapist were invited to evaluate and rank the quality of these guidelines using AGREE II.2.We selected a comprehensive hospital in Shanghai by cluster sampling method and conducted a cross-sectional survey of all the inpatients in that hospital from March 1,2018 to June 1,2018.Through bed visiting and electronic medical records checking,patients on oxygen therapy were ensured,and general information such as gender,age and department were recorded.A questionnaire on oxygen therapy survey for inpatients,designed by Neves et al,was used to collect the clinical data such as diagnosis,indications,prescriptions and real parameters.Another self-designed questionnaire on comfort level of oxygen therapy was further used to record the complaint from those who inhaler oxygen via nasal cannula while meeting the inclusion and exclusion criteria.3.Data were analyzed by SPSS software 22.0.Chi-square test was used to compare the rate and composition ratio between groups while Chi-square partition method on post hoc multiple Comparisons.A Logistic analysis（Forward:LR）was used to discuss the influencing factor.Testing levelαwas set at 0.05,and the difference was statistically significant if P value less than 0.05.Result:1.A total of 314 literature were retrieved.After excluding duplicate literature,guide introduction,guide interpretation,clinical research and other unrelated studies,we finally included three national-level clinical oxygen therapy guidelines.The 2017 British Thoracic Society（BTS）guideline scored higher than other two in all dimensions（Scope and purpose 87.0,Stakeholder involvement 79.6,Rigour of development 76.4,Clarity of presentation 83.3,Applicability 76.4,Editorial independence 75.0）and belonged to recommend level in the last.So,we thought it can be chosen as theoretical guidance and gold standard for follow-up research.2.The overall prevalence of oxygen therapy in hospitalized patients during the investigation period was 22.65%（464/2049）.There were differences in oxygen therapy prevalence,device selection and parameter setting among different departments as well different level wards.According to the gold standard,the reasonable rate of oxygen therapy in the hospital was 92.2%（8 cases had no indication on oxygen therapy,28 cases use oxygen without evidence of hypoxaemia）and the specification rate was 22.4%（349prescriptions were incomplete,18 prescriptions did not accord to the practical application,2 cases did not meet the required SatO₂）.3.The comfort rate of oxygen therapy via nasal cannula was 79.3%.Multivariate analysis showed that patients who inhaled oxygen flow rate higher than 4L/min[OR=31.623,P<0.05],time over 15h/d[OR=41.880,P<0.05],frequency more than twice per day[OR=21.607,P<0.05]and had a history of chronic rhinitis[OR=4.975,P<0.05]were more likely to cause discomfort.Conclusion:1.BTS guideline for oxygen use in adults in healthcare and emergency settings is a world-wide high-quality guideline,and it can be used as the theoretical guidance and practical standard of clinical oxygen therapy.Since there is no systematic guide or consensus in China,medical staff should learn from it and use it to guide clinical practice.2.Oxygen therapy is still the most common treatment in hospital at present,but varies in different departments and wards.Although its rationality is still acceptable,the standardization needs to be improved urgently,and the incomplete issuance of prescription is the most common cause.3.The comfort rate of patients receiving oxygen via nasal cannula is acceptable.High flow rate,long duration,multiple frequency and history of chronic rhinitis may be the risk factors for uncomfortable oxygen therapy.4.Medical staff and relevant departments should fully recognize the above characteristics and shortcomings of oxygen therapy.Active measures must be taken to standardize and improve clinical oxygen use in order to ensure patients with a safe,reasonable and comfortable clinical therapy environment.