Hyperoxemia and long-term outcome after traumatic brain injury

Critical Care

Markus Skrifvars²  Maarit Lång³  Jari Siironen¹  Riku Kivisaari¹  Matti Reinikainen⁴  Stepani Bendel³  Rahul Raj¹ 

[1] Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5FI-00029 HUS Helsinki,Finland;Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland;Department of Intensive Care Medicine, Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, 70211 Kuopio,Finland;Department of Intensive Care Medicine, North Karelia Central Hospital, Tikkamäentie 16, 80210 Joensuu, Finland

关键词: Mechanical ventilation;    Mortality;    Intensive care;    Hyperoxemia;    Traumatic brain injury;    Oxygenation;    Neurocritical care;    Arterial oxygen tension;   

Others  :  817899
DOI  :  10.1186/cc12856

 received in 2013-05-07, accepted in 2013-08-06,  发布年份 2013

【 摘 要 】

Introduction

The relationship between hyperoxemia and outcome in patients with traumatic brain injury (TBI) is controversial. We sought to investigate the independent relationship between hyperoxemia and long-term mortality in patients with moderate-to-severe traumatic brain injury.

Methods

The Finnish Intensive Care Consortium database was screened for mechanically ventilated patients with a moderate-to-severe TBI. Patients were categorized, according to the highest measured alveolar-arterial O₂ gradient or the lowest measured PaO₂ value during the first 24 hours of ICU admission, to hypoxemia (<10.0 kPa), normoxemia (10.0 to 13.3 kPa) and hyperoxemia (>13.3 kPa). We adjusted for markers of illness severity to evaluate the independent relationship between hyperoxemia and 6-month mortality.

Results

A total of 1,116 patients were included in the study, of which 16% (n = 174) were hypoxemic, 51% (n = 567) normoxemic and 33% (n = 375) hyperoxemic. The total 6-month mortality was 39% (n = 435). A significant association between hyperoxemia and a decreased risk of mortality was found in univariate analysis (P = 0.012). However, after adjusting for markers of illness severity in a multivariate logistic regression model hyperoxemia showed no independent relationship with 6-month mortality (hyperoxemia vs. normoxemia OR 0.88, 95% CI 0. 63 to 1.22, P = 0.43; hyperoxemia vs. hypoxemia OR 0.97, 95% CI 0.63 to 1.50, P = 0.90).

Conclusion

Hyperoxemia in the first 24 hours of ICU admission after a moderate-to-severe TBI is not predictive of 6-month mortality.

【 授权许可】

   
2013 Raj et al.; licensee BioMed Central Ltd.

【 图 表 】

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