Objective: We determined the prevalences of hyperoxemia and excessive oxygen use, and the epidemiology, ventilation characteristics and outcomes associated with hyperoxemia in invasively ventilated patients with coronavirus disease 2019 (COVID–19). Methods: Post hoc analysis of a national, multicentre, observational study in 22 ICUs. Patients were classified in the first two days of invasive ventilation as ‘hyperoxemic’ or ‘normoxemic’. The co–primary endpoints were prevalence of hyperoxemia (PaO2 > 90 mmHg) and prevalence of excessive oxygen use (FiO2 ≥ 60% while PaO2 > 90 mmHg or SpO2 > 92%). Secondary endpoints included ventilator settings and ventilation parameters, duration of ventilation, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, and at day 28 and 90. We used propensity matching to control for observed confounding factors that may influence endpoints. Results: Of 851 COVID–19 patients, 225 (26.4%) were classified as hyperoxemic. Excessive oxygen use occurred in 385 (45.2%) patients. Acute respiratory distress syndrome (ARDS) severity was lowest in hyperoxemic patients. Hyperoxemic patients were ventilated with higher positive end–expiratory pressure (PEEP), while rescue therapies for hypoxemia were applied more often in normoxemic patients. Neither in the unmatched nor in the matched analysis were there differences between hyperoxemic and normoxemic patients with regard to any of the clinical outcomes. Conclusion: In this cohort of invasively ventilated COVID–19 patients, hyperoxemia occurred often and so did excessive oxygen use. The main differences between hyperoxemic and normoxemic patients were ARDS severity and use of PEEP. Clinical outcomes were not different between hyperoxemic and normoxemic patients.
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News media in The Netherlands show great variety in the extent and ways, in which they realize media accountability online in terms of actor transparency, product transparency and feedback opportunities online. It is suggested that even those news rooms that seem to adhere to transparency and public accountability still need to explore the functionality and application of media accountability instruments (MAI). Both in terms of potentials and pitfalls, news rooms need to consider about what they want to be transparent and in what ways. To the extent that online innovations are visible, traditional news media seem to experiment, as is the case with newsroom blogs or the project of hyper local journalism Dichtbij.nl, part of the Telegraaf Company. Various news media have on-going projects on audience participation, online applications and distribution models. However, since many projects merely aim at finding new applications, processes, platforms and business models, it remains to be seen assess whether projects are indeed reasonably innovative and feasible at the same time. The development of an online and therefore immediate, archived, personalized and interactive context, offers practical and ethical challenges to Dutch journalism. These challenges bring shifts in its role and responsibility to society. It means that changes occur in what journalists are accountable for, as well as ways in how they are accountable. The Dutch media landscape lodges various professional accountability instruments like the press council and both profession-wide and news media specific codes of ethics, but some of these instruments receive only moderate support. Proactive openness is more an exception than the rule and may well be a distinctive indicator for quality journalism. Although news media often acknowledge the importance of media accountability offline and online, they often lack the resources or courage to use them or have different priorities. This ambiguous position may indicate that in relation to media accountability online, Dutch news media are between hope and fear: that it will either improve their relationship with the public and fuel professional quality, or ask too much of resources with too little benefit.
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