Early exposure to hyperoxia and mortality in critically ill patients with severe traumatic injuries

BMC Pulmonary Medicine

Research Article

Addison K. May¹  Gordon R. Bernard¹  Tatsuki Koyama¹  Lorraine B. Ware¹  Zhiguo Zhao¹  William L. Emerson¹  Derek W. Russell²  David R. Janz³ 

[1] Departments of Medicine and Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN, USA;Lung Health Center, Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, 1900 University Blvd., THT 423, 35233, Birmingham, AL, USA;Section of Pulmonary and Critical Care Medicine, Louisiana State University School of Medicine New Orleans, New Orleans, LA, USA;

关键词: Traumatic Brain Injury;    Head Injury;    Glasgow Coma Scale;    Injury Severity Score;    Traumatic Brain Injury Patient;   

DOI  :  10.1186/s12890-017-0370-1

 received in 2016-07-06, accepted in 2017-01-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundHyperoxia is common early in the course of resuscitation of critically ill patients. It has been associated with mortality in some, but not all, studies of cardiac arrest patients and other critically ill cohorts. Reasons for the inconsistency are unclear and may depend on unmeasured patient confounders, the timing and duration of hyperoxia, population characteristics, or the way that hyperoxia is defined and measured. We sought to determine whether, in a prospectively collected cohort of mechanically ventilated patients with traumatic injuries with and without head trauma, higher maximum partial pressure of arterial oxygen (PaO2) within 24 hours of admission would be associated with increased risk of in-hospital mortality.MethodsCritically ill patients with traumatic injuries undergoing invasive mechanical ventilation enrolled in the Validating Acute Lung Injury biomarkers for Diagnosis (VALID) study were included in this study. All arterial blood gases (ABGs) from the first 24 hours of admission were recorded. Primary analysis was comparison of the highest PaO2 between hospital survivors and non-survivors.ResultsA total of 653 patients were evaluated for inclusion. Of these, 182 were not mechanically ventilated or did not have an ABG measured in the first 24 hours, leaving 471 patients in the primary analysis. In survivors, the maximum PaO2 was 141 mmHg (median, interquartile range 103 - 212) compared to 148 mmHg (IQR 105 - 209) in non-survivors (p = 0.82). In the subgroup with head trauma (n = 266), the maximum PaO2 was 133 mmHg (IQR 97 - 187) among survivors and 152 mmHg (108 - 229) among nonsurvivors (p = 0.19). After controlling for age, injury severity score, number of arterial blood gases, and fraction of inspired oxygen, maximum PaO2 was not associated with increased mortality (OR 1.27 for every fold increase of PaO2 (95% CI 0.72 - 2.25).ConclusionsIn mechanically ventilated patients with severe traumatic injuries, hyperoxia in the first 24 hours of admission was not associated with increased risk of death or worsened neurological outcomes in a setting without brain tissue oxygenation monitoring.

【 授权许可】

CC BY   
© The Author(s). 2017