Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry

Critical Care

Guillaume Dubreuil¹  Paer-Selim Abback²  Jean-Denis Moyer²  Catherine Paugam-Burtz²  Delphine Garrigue³  Fleur Laloum⁴  Julien Pottecher⁵  Philippe Laitselart⁶  Mathieu Raux⁷  Benoit Champigneulle⁸  Marouane Boubaya⁹  Coralie Bloch-Queyrat⁹  Frédéric Adnet^1,10  Josefine S. Baekgaard^1,11 

[1] Department of Anesthesia and Critical Care, AP-HP, Bicêtre Hospital, Paris, France;Department of Anesthesia and Critical Care, Beaujon Hospital, AP-HP, University of Paris, Paris, France;Department of Anesthesia and Critical Care, CHU de Lille, Lille, France;Department of Anesthesia and Critical Care, University Hospital of Reims, Reims, France;Department of Anesthesia and Surgical Critical Care, Strasbourg University Hospital, Strasbourg, France;Department of Anesthesia, Percy Army Training Hospital, Paris, France;Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d’Anesthésie Réanimation, F-75013, Paris, France;Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France;URC CRC, Avicenne Hospital, Bobigny, France;Urgences et Samu 93, AP-HP, Avicenne Hospital, Inserm U942, 93000, Bobigny, France;Urgences et Samu 93, AP-HP, Avicenne Hospital, Inserm U942, 93000, Bobigny, France;Department of Anesthesia, Section 4231, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100, Copenhagen, Denmark;

关键词: Hyperoxemia;    Hyperoxia;    Trauma;    Critical care;    Oxygen;   

DOI  :  10.1186/s13054-020-03274-x

来源: Springer

【 摘 要 】

BackgroundHyperoxemia has been associated with increased mortality in critically ill patients, but little is known about its effect in trauma patients. The objective of this study was to assess the association between early hyperoxemia and in-hospital mortality after severe trauma. We hypothesized that a PaO2 ≥ 150 mmHg on admission was associated with increased in-hospital mortality.MethodsUsing data issued from a multicenter prospective trauma registry in France, we included trauma patients managed by the emergency medical services between May 2016 and March 2019 and admitted to a level I trauma center. Early hyperoxemia was defined as an arterial oxygen tension (PaO2) above 150 mmHg measured on hospital admission. In-hospital mortality was compared between normoxemic (150 > PaO2 ≥ 60 mmHg) and hyperoxemic patients using a propensity-score model with predetermined variables (gender, age, prehospital heart rate and systolic blood pressure, temperature, hemoglobin and arterial lactate, use of mechanical ventilation, presence of traumatic brain injury (TBI), initial Glasgow Coma Scale score, Injury Severity Score (ISS), American Society of Anesthesiologists physical health class > I, and presence of hemorrhagic shock).ResultsA total of 5912 patients were analyzed. The median age was 39 [26–55] years and 78% were male. More than half (53%) of the patients had an ISS above 15, and 32% had traumatic brain injury. On univariate analysis, the in-hospital mortality was higher in hyperoxemic patients compared to normoxemic patients (12% versus 9%, p < 0.0001). However, after propensity score matching, we found a significantly lower in-hospital mortality in hyperoxemic patients compared to normoxemic patients (OR 0.59 [0.50–0.70], p < 0.0001).ConclusionIn this large observational study, early hyperoxemia in trauma patients was associated with reduced adjusted in-hospital mortality. This result contrasts the unadjusted in-hospital mortality as well as numerous other findings reported in acutely and critically ill patients. The study calls for a randomized clinical trial to further investigate this association.

【 授权许可】

CC BY