Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: a retrospective nested cohort study

Background: In mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both. Methods: We evaluated the introduction of conservative oxygen therapy (target SpO2 88-92% using the lowest FiO2) during MV for resuscitated CA patients admitted to the ICU. Results: We studied 912 arterial blood gas (ABG) datasets: 448 ABGs from 50 'conventional' and 464 ABGs from 50 'conservative' oxygen therapy patients. Compared to the conventional group, conservative group patients had significantly lower PaO2 values and FiO2 exposure (p <0.001, respectively); more received MV in a spontaneous ventilation mode (18% vs 2%; p =0.001) and more were exposed to a FiO 2 of 0.21 (19 vs 0 patients, p =0.001). Additionally, according to mean PaO2, more conservative group patients were classified as normoxaemic (36 vs 16 patients, p <0.01) and fewer as hyperoxaemic (14 vs 33 patients, p <0.01). Finally, ICU length of stay was significantly shorter for conservative group patients (p =0.04). There was no difference in the proportion of survivors discharged from hospital with good neurological outcome (14/23 vs 12/22 patients, p =0.67). Conclusions: Our findings provide preliminary support for the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU for MV support after cardiac arrest (Trial registration, NCT01684124).

Prioritizing social and moral learning amid conservative curriculum trends: spaces of possibility

Conservative trends across western schooling contexts are signalling an explicit devaluing of social and moral learning within their official curriculum mandates. These mandates are increasingly privileging the ‘academic rigour’ of traditional subject disciplines. This paper draws on interview and observation data from a case study of a large and highly diverse English secondary school to explore this school’s prioritizing of social and moral learning. Such prioritizing is supported at this school by its ‘Academy’ status—which in the English context allows schools a measure of freedom over curriculum as part of broader government moves to increase school autonomy. The paper’s focus is on how these conservative trends are understood and disrupted to support a critical view of existing curriculum and a desire to modify and re-shape it to support more relevant and connected learning for students. The paper describes particular examples of practice at the school in the areas of Citizenship and Religious Education to illustrate this approach. Engaging with social and moral learning along these lines is argued as productive in working within and against the constraints of current conservative curriculum priorities.