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Original Research: Critical Care |

An Educational Intervention Optimizes the Use of Arterial Blood Gas Determinations Across ICUs From Different Specialties: A Quality-Improvement Study

Carlos D. Martínez-Balzano, MD; Paulo Oliveira, MD; Michelle O’Rourke, DAP ACBP-BC; Luanne Hills, BS, RRT; Andrés F. Sosa, MD, FCCP
Author and Funding Information

C. M. B. is now in the Division of Pulmonary, Critical Care and Sleep Medicine at SUNY Upstate Medical University, Syracuse, NY.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDivision of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA

bDepartment of Nursing, UMass Memorial Healthcare Center, Worcester, MA

cDepartment of Respiratory Care, UMass Memorial Healthcare Center, Worcester, MA

CORRESPONDENCE TO: Andrés F. Sosa, MD, FCCP, South Florida Pulmonary and Critical Care, 8900 North Kendall Dr, Miami, FL 33176


Copyright 2016, . All Rights Reserved.


Chest. 2017;151(3):579-585. doi:10.1016/j.chest.2016.10.035
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Background  Overuse of arterial blood gas (ABG) determinations leads to increased costs, inefficient use of staff work hours, and patient discomfort and blood loss. We developed guidelines to optimize ABG use in the ICU.

Methods  ABG use guidelines were implemented in all adult ICUs in our institution: three medical, two trauma-surgery, one cardiovascular, and one neurosurgical ICU. Although relying on pulse oximetry, we encouraged the use of ABG determination after an acute respiratory event or for a rational clinical concern and discouraged obtaining ABG measurements for routine surveillance, after planned changes of positive end-expiratory pressure or Fio2 on the mechanical ventilator, for spontaneous breathing trials, or when a disorder was not suspected. ABG measurements and global ICU metrics were collected before (year 2014) and after (year 2015) the intervention.

Results  We saw a reduction of 821.5 ± 257.4 ABG determinations per month (41.5%), or approximately one ABG determination per patient per mechanical ventilation (MV) day for each month (43.1%), after introducing the guidelines (P < .001). This represented 49 L of saved blood, a reduction of $39,432 in the costs of ICU care, and 1,643 staff work hours freed for other tasks. Appropriately indicated tests rose to 83.4% from a baseline 67.5% (P = .002). Less than 5% of inappropriately indicated ABG determinations changed patient management in the postintervention period. There were no significant differences in MV days, severity of illness, or ICU mortality between the two periods.

Conclusions  The large scale implementation of guidelines for ABG use reduced the number of inappropriately ordered ABG determinations over seven different multidisciplinary ICUs, without negatively impacting patient care.

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