Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis

Abstract

IntroductionThe safety of arterial hyperoxia is under increasing scrutiny. We performed a systematic review of the literature to determine whether any association exists between arterial hyperoxia and mortality in critically ill patient subsets.MethodsMedline, Thomson Reuters Web of Science and Scopus databases were searched from inception to June 2014. Observational or interventional studies evaluating the relationship between hyperoxia (defined as a supranormal arterial O2 tension) and mortality in adult intensive care unit (ICU) patients were included. Studies primarily involving patients with exacerbations of chronic pulmonary disease, acute lung injury and perioperative administration were excluded. Adjusted odds ratio (OR) of patients exposed versus those not exposed to hyperoxia were extracted, if available. Alternatively, unadjusted outcome data were recorded. Data on patients, study characteristics and the criteria used for defining hyperoxia exposure were also extracted. Random-effects models were used for quantitative synthesis of the data, with a primary outcome of hospital mortality.ResultsIn total 17 studies (16 observational, 1 prospective before-after) were identified in different patient categories: mechanically ventilated ICU (number of studies (k) = 4, number of participants (n) = 189,143), post-cardiac arrest (k = 6, n = 19,144), stroke (k = 2, n = 5,537), and traumatic brain injury (k = 5, n = 7,488). Different criteria were used to define hyperoxia in terms of PaO2 value (first, highest, worst, mean), time of assessment and predetermined cutoffs. Data from studies on ICU patients were not pooled because of extreme heterogeneity (inconsistency (I2) 96.73%). Hyperoxia was associated with increased mortality in post-cardiac arrest patients (OR = 1.42 (1.04 to 1.92) I2 67.73%) stroke (OR = 1.23 (1.06 to 1.43) I2 0%) and traumatic brain injury (OR = 1.41 (1.03 to 1.94) I2 64.54%). However, these results are limited by significant heterogeneity between studies.ConclusionsHyperoxia may be associated with increased mortality in patients with stroke, traumatic brain injury and those resuscitated from cardiac arrest. However, these results are limited by the high heterogeneity of the included studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0711-x) contains supplementary material, which is available to authorized users.

Should a Portable Ventilator Be Used in All In-Hospital Transports?

“…Inappropriate tidal volumes have been identified as an independent risk factor contributing to increased mortality and length of hospital stay, 16,43 and hyperoxia, for even short periods, has been shown to worsen outcomes and increase mortality in select patient populations. 25 With hospital reimbursement tied directly to patient outcomes, minimizing risks while improving patient safety is a financial necessity. The average daily cost of a mechanically ventilated patient is estimated at $4,000, 44 and the number of patients requiring prolonged ventilation alone is expected to exceed 600,000 by 2020.…”

“…23 Exposure to high oxygen concentrations has also been shown to be detrimental in various adult patient populations. 24,25 Cardiovascular responses to hyperoxemia include: reduced stroke volume and cardiac output, increased peripheral vascular resistance, and coronary artery vasoconstriction. 26 Oxygen toxicity from exposure to high levels of oxygen worsens lung function.…”

Deneysel Rat Modeli: Anestezi İndüksiyonu Öncesi %100 O2 İle Preoksijenizasyon Uygun mu Değil mi?

“…It has also been observed how accurate the definition of Hafner (double-edge sword) for oxygen was, in our study [3] . It is clear that hyperoxia has potency to be detrimental even in a wide variety of clinical conditions in intensive care units [15] . In 2008, the British Thoracic Society published a guide for emergency oxygenation in adult patients [16] .…”

The WHO recommendation for 80% perioperative oxygen is poorly justified

“…The international liaison committee on resuscitation no longer supports the use of supplemental oxygen as long as peripheral saturation (SpO2) is >94% [18]. Several meta-analyses [5,19] concluded that hyperoxaemia may be associated with increased mortality in patients with stroke, traumatic brain injury, and those resuscitated after cardiac arrest. Supplemental oxygen may be associated with increased mortality after emergency admissions [25].…”