Oxygen Stewardship in Adult Critical Care: A Quality Improvement Initiative.
Wei Jun Dan Ong, Glen JiaXin Li, Lawrence Matunan Ace Azul and 5 others
PMID 41940418WHAT IT FOUND
In an adult ICU, an oxygen weaning and monitoring programme reduced the proportion of patient-days outside target oxygen saturation from 63% to 20%, sustained over 12 months, with lower oxygen use; no clinical outcomes were measured.
Key findings
01After implementation, the median proportion of patient-days outside prescribed oxygen saturation targets decreased from 63% to 20%.
02Total estimated oxygen consumption per patient-day declined after implementation, with significant reductions for conventional oxygen therapy, non-invasive ventilation and mechanical ventilation; the high-flow nasal cannula reduction did not reach significance.
03Routine incident reporting identified no increase in clinically significant hypoxia or adverse respiratory events, but formal safety endpoints were not systematically collected.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-centre before-and-after quality improvement evaluation without adjustment for illness severity or case mix, so observed changes may reflect secular trends, case mix or illness severity rather than the intervention. The intervention combined a standardised weaning protocol, multidisciplinary education, audit and feedback, and iterative PDSA refinements; the contribution of any single component cannot be separated. Clinical outcomes such as ICU length of stay and mortality were not prespecified or assessed. Safety was not formally measured: desaturation events and escalations in respiratory support were not systematically collected, and the absence of adverse events was based on routine incident reporting. Oxygen consumption estimates relied on documented settings and time-weighted assumptions rather than continuous high-resolution measurement. Staff survey and interview findings were voluntary, anonymised and reported at group level, and may not reflect all ICU staff or generalise beyond this unit. High-flow nasal cannula use showed a numerical reduction that did not reach significance, and staff interviews highlighted persistent uncertainty about weaning in this modality.
Declared interests
The authors reported no funding or conflicts of interest.
The easy way to misread this
Do not conclude that oxygen weaning and monitoring improves patient recovery, length of stay or mortality; this evaluation measured process adherence and oxygen consumption, not clinical outcomes, and formal safety endpoints were not systematically collected.