Attitudes of Dutch intensive care unit clinicians towards oxygen therapy.

BACKGROUND: Over the last decade, there has been an increasing awareness for the potential harm of the administration of too much oxygen. We aimed to describe self-reported attitudes towards oxygen therapy by clinicians from a large representative sample of intensive care units (ICUs) in the Netherlands. METHODS: In April 2019, 36 ICUs in the Netherlands were approached and asked to send out a questionnaire (59 questions) to their nursing and medical staff (ICU clinicians) eliciting self-reported behaviour and attitudes towards oxygen therapy in general and in specific ICU case scenarios. RESULTS: In total, 1361 ICU clinicians (71% nurses, 24% physicians) from 28 ICUs returned the questionnaire. Of responding ICU clinicians, 64% considered oxygen-induced lung injury to be a major concern. The majority of respondents considered a partial pressure of oxygen (PaO2) of 6-10 kPa (45-75 mmHg) and an arterial saturation (SaO2) of 85-90% as acceptable for 15 minutes, and a PaO2 7-10 kPa (53-75 mmHg) and SaO2 90-95% as acceptable for 24-48 hours in an acute respiratory distress syndrome (ARDS) patient. In most case scenarios, respondents reported not to change the fraction of inspired oxygen (FiO2) if SaO2 was 90-95% or PaO2 was 12 kPa (90 mmHg). CONCLUSION: A representative sample of ICU clinicians from the Netherlands were concerned about oxygen-induced lung injury, and reported that they preferred PaO2 and SaO2 targets in the lower physiological range and would adjust ventilation settings accordingly.

Diagnostic imaging in abdominal neuroblastoma: is there a complementary role of MIBG-scintigraphy and ultrasonography?

UNLABELLED: In a retrospective study we evaluated the agreement between the results of meta-iodo benzylguanidine (MIBG) scintigraphy and abdominal ultrasonography (US) in the diagnosis and follow up of neuroblastoma (NBL) with respect to the abdominal region. Data of 28 consecutive paediatric patients with NBL or suspected NBL were included (16 M/12 F, mean age 2.9 years, range 3 weeks-13.4 years). The results (as judged by the nuclear physician or radiologist, respectively) of 60 MIBG examinations (123I and 131I) including 26 single photon emission computed tomography (SPECT) and US, respectively, performed within a period of 14 days, could be evaluated. Full agreement was reached in 37 comparisons (62%), while partial and no agreement was found in 17 (28%), and 6 (10%) comparisons respectively. In 8 out of 37 comparisons with full agreement, 12 diagnosed lesions were histopathologically proven, while 11 comparisons with negative findings were also negative in other clinical modalities. US diagnosed correctly in 68% of the histopathological proven lesions, while this was 54% for MIBG scintigraphy. In approximately 50% of the MIBG scans in which SPECT was available, SPECT provided significant additional information. CONCLUSION: Congruent results of MIBG scintigraphy and ultrasonography in the detection of abdominal lesions in patients with suspected neuroblastoma indicate a high reliability in the diagnosis and localisation. Due to the favourable results of additional SPECT, it is advisable to perform SPECT routinely in this diagnosis.