IS IT TIME TO TAKE THE “O” OUT OF “M.O.N.A.”? UNIVERSITY OF MARYLAND BALTIMORE WASHINGTON MEDICAL CENTER GLEN BURNIE, MD Printing: Felicia Caughlin, RN, Cassie Johnson, RN, & Asisat Popoola, RN This poster is 48” wide by 36” high. It’s designed to be printed on a PURPOSE METHODS RECOMMENDATIONS large To assess the use of supplemental oxygen during a Databases: Cochrane Review, CINAHL, Medline myocardial infarction in patients with oxygen Apply oxygen based on patient saturation above 95% without supplemental Search terms: Oxygen toxicity, acute coronary syndrome, chest pain management, myocardial infarction, oxygen, oxygen saturation. oxygen. cost of oxygen usage Customizing the Content: . Current UM BWMC guideline is to place The placeholders in this Limits: Less than 5 years since publication, randomized monitored patients experience chest pain on 4L controlled studies, systematic reviews BACKGROUND of supplemental oxygen (2L for COPD formatted for you. patients). All evidence was appraised using the Johns Hopkins placeholders to add text, or click According to UMBWMC’s current Chest Pain Nursing Evidence-Based Practice appraisal tools. . There is no benefit of supplemental oxygen in an icon to add a table, chart, Management of the Monitored Patient normoxemic (O2Saturation >95%) patients. guidelines, the RN is to apply oxygen in the RESULTS SmartArt graphic, picture or event of a myocardial infarction regardless of multimedia file. patient oxygen saturation Study Level of Evidence Results Limitations Implement guideline change. Cabello et Level 1A No clear effect of oxygen on Three studies reviewed had . UMMS U web-based and in-service training al, 2016 Systematic Review infarct size. no randomization. T Use of unnecessary supplemental oxygen is Borderline statistical Only 1 study was double should be included in implementation of the potentially: significance of increased blinded. new guideline. from text, just click the Bullets infarct size in the oxygen  Wasteful (time, resources, money) group compared to air button on the Home tab. group.  Harmful Hofmann Level 1A No significant difference Not double blind Potential Stakeholders: If you need more placeholders for et al, 2017 RCT between oxygen and air End point measure from two groups. different registries . Nursing Policy, Procedures, and Guidelines Informed consent required titles, Committee Fu et al, Level 1A Oxygen did not reduce Quality of studies was low PICO QUESTION 2017 Small sample sizes make a copy of what you need and Systematic Review short-term death . Cardiac Collaborative Team Oxygen significantly Small number of studies Only compared normal pressure increased the rate of drag it into place. PowerPoint’s In adult patients experiencing chest pain, oxygen with oxygen group did recurrent myocardial not include hyperbaric oxygen what is the effect on patient outcomes when infarction. Did not account for REFERENCES Smart Guides will help you align it supplemental oxygenation is only used in anticoagulation or percutaneous interventions Cabello, J. B., Burls, A., Emparanza, J.L., Bayliss, S.E., & Quinn, T. (2016). Oxygen Therapy For with everything else. cases of hypoxemia? Acute Myocardial Infarction. Cochrane of Database Systematic Reviews 2016, 12, DOI: Stub et al, Level 1A Increased frequency of Treatment allocation was not 10.1002/14651858.CD007160.pub4. 2015) RCT recurrent MI in oxygen blinded to paramedics, patients, group or in-hospital cardiology Want to use your own pictures P:Adult patients experiencing chest pain Powered to detect group Increased frequency of Fu, S., Lv, X., Fang, Q., & Liu, Z. (2017). Oxygen therapy for acute myocardial infarction: A differences in initial MI injury systematic review and meta-analysis. International Journal Of Nursing Studies, 748-14. instead of ours? No problem! Just cardiac arrhythmia in based on biomarker profiles doi:10.1016/j.ijnurstu.2017.04.005 I:Oxygen therapy provided only in cases of oxygen group rather than major adverse Increase in creatinine kinase cardiac events right hypoxemia Need more patients in oxygen group Hofmann, R., James, S. K., Jernberg, T., Lindahl, B., Erlinge, D., Witt, N., & ... Pernow, J. Number of patients who did not (2017). Oxygen Therapy in Suspected Acute Myocardial Infarction. New England Journal Of Change Picture. Maintain the have STEMI being excluded Medicine, 377(13), 1240-1249. doi:10.1056/NEJMoa1706222 C:Oxygen therapy for all chest pain cases from primary end-point proportion of pictures as you resize Not all patients underwent CMR at 6 months post-infarct by dragging a corner. *More research would be required to determine if oxygen use in patients with oxygen Stub, D., Smith, K., Bernard, S., Nehme, Z., Stephenson, M., Bray, J. E., & ... Kaye, D. M. O:The same or improved outcome for patients (2015). Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation, 131(24), saturation above 95% is linked to poor patient outcome. 2143-2150. doi:10.1161/CIRCULATIONAHA.114.014494