Can guidelines rein in oxygen use? A retrospective cross-sectional study using routinely collected data

Area of Science:

• Medical Research
• Clinical Practice
• Public Health

Background:

• Oxygen is a critical emergency therapy, but inappropriate use can lead to harm.
• New guidelines for oxygen and medication use were issued during the COVID-19 pandemic to optimize patient care.
• Assessing adherence to these guidelines is crucial for evaluating their effectiveness.

Purpose of the Study:

• To evaluate the concordance of oxygen and medication administration with newly released COVID-19 guidelines during the pandemic's first wave.
• To identify factors associated with oxygen over-administration and under-administration.
• To assess the uptake of dexamethasone guidelines.

Main Methods:

• Retrospective cross-sectional study of 8751 COVID-19 patients admitted between April and September 2020.
• Analysis of SpO2 adherence to oxygen guidelines, stratified by chronic obstructive pulmonary disease (COPD) status.
• Multinomial regression to identify factors related to oxygen use and calculation of dexamethasone administration rates.

Main Results:

• Oxygen was administered within guidelines only 41.6% of the time, with over-administration (55.0%) being significantly more common than under-administration (3.5%).
• Adherence was lower in patients with COPD (25.2%) compared to those without (43.7%), with higher over-administration rates in the COPD group (71.8%).
• Only 12.6% of eligible patients received dexamethasone after the guideline update.

Conclusions:

• Suboptimal use of both oxygen and medication was prevalent during the initial phase of the COVID-19 pandemic.
• Existing guidelines alone were insufficient to ensure optimal oxygen therapy use.
• Behavioral strategies and policy interventions are needed to improve oxygen and medication management in clinical practice.