Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis

World Journal of Emergency Surgery

on behalf of the Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group¹  Naoshi Takeyama²  Norio Yamashita³  Ryosuke Tsuruta⁴  Akiyoshi Hagiwara⁵  Seitaro Fujishima⁶  Yasukazu Shiino⁷  Satoshi Gando⁸  Toshihiko Mayumi⁹  Hiroto Ikeda^1,10  Shin-Ichiro Shiraishi^1,11  Taka-aki Nakada^1,12  Ryo Yamamoto^1,13  Junichi Sasaki^1,13  Tomohiko Masuno^1,14  Toru Hifumi^1,15  Toshikazu Abe^1,16  Kohji Okamoto^1,17  Takehiko Tarui^1,18  Masashi Ueyama^1,19  Hiroshi Ogura^2,20  Joji Kotani^2,21  Shigeki Kushimoto^2,22  Kazuma Yamakawa^2,23  Daizoh Saitoh^2,24  Kiyotsugu Takuma^2,25  Yuichiro Sakamoto^2,26  Atsushi Shiraishi^2,27  Yasuhiro Otomo^2,28 

[1] ;Advanced Critical Care Center, Aichi Medical University Hospital;Advanced Emergency Medical Service Center, Kurume University Hospital;Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital;Center Hospital of the National Center for Global Health and Medicine;Center for General Medicine Education, Keio University School of Medicine;Department of Acute Medicine, Kawasaki Medical School;Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital;Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health;Department of Emergency Medicine, Teikyo University School of Medicine;Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital;Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine;Department of Emergency and Critical Care Medicine, Keio University School of Medicine;Department of Emergency and Critical Care Medicine, Nippon Medical School;Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital;Department of General Medicine, Juntendo University;Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital;Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine;Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital;Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine;Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine;Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine;Division of Trauma and Surgical Critical Care, Osaka General Medical Center;Division of Traumatology, Research Institute, National Defense Medical College;Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital;Emergency and Critical Care Medicine, Saga University Hospital;Emergency and Trauma Center, Kameda Medical Center;Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University;

关键词: Hyperoxemia;    Hyperoxia;    Trauma;    Critically ill;    ICU length of stay;    Mortality;   

DOI  :  10.1186/s13017-021-00363-2

来源: DOAJ

【 摘 要 】

Abstract Background Information on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes. Methods A post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models. Results Among 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay. Conclusions Hyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED. Trial registration UMIN-CTR, UMIN000019588 . Registered on November 15, 2015.

【 授权许可】

Unknown