Five 'Quick Hits' in Hospital Medicine

William J. Collins, MD

Disclosures

June 18, 2019

In This Article

The More We Know in Hospital Medicine

The more you know, the more you know you don't know.
—Aristotle (attributed)

William Collins, MD

Keeping up with all of the latest trials relevant to hospitalists can be daunting. From an overwhelming volume of material, we search for nuggets of information with the potential to improve practice. I am always motivated to learn something new or come across data that challenge the current practice of hospital medicine.

That's why I've made it a regular goal to create quick-hit summaries of recent studies and their take-home points, and I am excited to share some of these here. The topics are wide-ranging but all are pertinent to hospital medicine.

Rethinking 'Oxygen for Comfort'

The IOTA systematic review[1] yielded compelling evidence that we should stop administering oxygen solely for the purpose of comfort.[1] IOTA aggregated 25 randomized controlled trials that compared liberal with conservative supplemental oxygen therapy in acutely ill adults. No morbidity or mortality benefits were found; to the contrary, liberal oxygen strategies were associated with higher 30-day mortality rates in a dose-dependent manner.

Far from being benign, hyperoxia from liberal oxygen therapy can be life-threatening.[1] The IOTA study findings prompted new "rapid recommendations" published by the BMJ advocating updated standards for oxygen therapy.[2] Here are their chief recommendations:

  • Recommendation 1: Stop oxygen therapy when saturation is > 96%.

  • Recommendation 2: Suggest not starting oxygen therapy for saturations 90%-92%.

  • Recommendation 3: Do not start oxygen therapy for saturation ≥ 93%.

  • Important exceptions to conservative oxygen therapy are sickle cell crisis, pneumothorax, carbon monoxide poisoning, and cluster headache.

An infographic summarizes these recommendations.

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