Annals for Hospitalists Inpatient Notes - Rethinking Oxygen Therapy for Hospitalized Patients
Bibliographic record
Abstract
Web Exclusives17 September 2019Annals for Hospitalists Inpatient Notes - Rethinking Oxygen Therapy for Hospitalized PatientsLisa H.Y. Kim, MD, Derek K. Chu, MD, PhD, and Waleed Alhazzani, MD, MScLisa H.Y. Kim, MDMcMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (L.H.K., D.K.C., W.A.)Search for more papers by this author, Derek K. Chu, MD, PhDMcMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (L.H.K., D.K.C., W.A.)Search for more papers by this author, and Waleed Alhazzani, MD, MScMcMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (L.H.K., D.K.C., W.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2502 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Oxygen therapy has been a critical life-saving measure since its first use for pneumonia in the 19th century. With its widespread use in contemporary medicine came the notion that supplemental oxygen is harmless, and that it may even be beneficial in nonhypoxemic patients. Over time, this conviction has become ingrained in clinical practice and the medical training of health care providers. Indeed, the classic mantra taught for any acutely ill patient is, “ABC IV O2 Monitor.”Among acutely ill patients, supplemental oxygen is one of the most commonly prescribed therapies; at least 25% of patients in emergency departments and 15% ...References1. O'Driscoll BR, Howard LS, Earis J, et al; British Thoracic Society Emergency Oxygen Guideline Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72:ii1-ii90. [PMID: 28507176] doi:10.1136/thoraxjnl-2016-209729 CrossrefMedlineGoogle Scholar2. Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018;391:1693-705. [PMID: 29726345] doi:10.1016/S0140-6736(18)30479-3 CrossrefMedlineGoogle Scholar3. Austin MA, Wills KE, Blizzard L, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010;341:c5462. [PMID: 20959284] doi:10.1136/bmj.c5462 CrossrefMedlineGoogle Scholar4. Siemieniuk RAC, Chu DK, Kim LH, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169. [PMID: 30355567] doi:10.1136/bmj.k4169 CrossrefMedlineGoogle Scholar5. Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376:784-93. [PMID: 20816546] doi:10.1016/S0140-6736(10)61115-4 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (L.H.K., D.K.C., W.A.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2502.Corresponding Author: Lisa H.Y. Kim, MD, Division of Respirology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue, Hamilton, Ontario L8N 4A6, Canada; e-mail, lisa.[email protected]ca.Current Author Addresses: Dr. Kim: Division of Respirology, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue, Hamilton, Ontario L8N 4A6, Canada.Dr. Chu: McMaster University Medical Centre, HSC - 3V49, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.Dr. Alhazzani: St. Joseph's Healthcare Hamilton, 50 Charlton Avenue, Hamilton, Ontario L8N 4A6, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 17 September 2019 David H. Wesorick and Vineet Chopra Annals On Call - Beware the Oxygen Fairy Robert M. Centor and Lisa H.Y. Kim Metrics 17 September 2019Volume 171, Issue 6Page: HO2-HO3KeywordsAttentionFraction of inspired oxygenHealth careHealth care providersHospitalistsHypoxiaMyocardial infarctionOxygenPneumoniaSepsis ePublished: 17 September 2019 Issue Published: 17 September 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.224 | 0.097 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".