Association Between Hyperoxia, Supplemental Oxygen, and Mortality in Critically Injured Patients

Douin, David J.; Anderson, E. L.; Dylla, Layne; Rice, John D.; Jackson, Conner; Wright, Franklin L.; Bebarta, Vikhyat S.; Schauer, Steven G; Ginde, Adit A.

doi:10.1097/cce.0000000000000418

Cited by 15 publications

(19 citation statements)

References 53 publications

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“…In the interim, supplemental oxygen therapy via mask-reservoir device with flow rate of 15L/min for polytrauma patients undoubtedly prevents the mortality and morbidity associated with hypoxia. 45 Target oxygen therapy should be considered after initial stabilization in trauma patients. Hypocalcemia: This can occur in patients with polytrauma due to rhabdomyolysis and massive blood transfusion.…”

Section: Managing Associated Risks During Polytrauma Managementmentioning

confidence: 99%

Risks in the Management of Polytrauma Patients: Clinical Insights

Iyengar¹,

Venkatesan²,

Jain³

et al. 2023

ORR

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Polytrauma, a patient’s condition with multiple injuries that involve multiple organs or systems, is the leading cause of mortality in young adults. Trauma-related injuries are a major public health concern due to their associated morbidity, high disability, associated death, and socioeconomic consequences. Management of polytrauma patients has evolved over the last few decades due to the development of trauma systems, improved pre-hospital assessment, transport and in-hospital care supported by complementary investigations. Recognising the mortality patterns in trauma has led to significant changes in the approach to managing these patients. A structured approach with application of advanced trauma life support (ATLS) algorithms and optimisation of care based on clinical and physiological parameters has led to the development of early appropriate care (EAC) guidelines to treat these patients, with subsequent improved outcomes in such patients. The journey of a polytrauma patient through the stages of pre-hospital care, emergency resuscitation, in-hospital stabilization and rehabilitation pathway can be associated with risks at any of these phases. We describe the various risks that can be anticipated during the management of polytrauma patients at different stages and provide clinical insights into early recognition and effective treatment of these to improve clinical outcomes.

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Section: Managing Associated Risks During Polytrauma Managementmentioning

confidence: 99%

Risks in the Management of Polytrauma Patients: Clinical Insights

Iyengar¹,

Venkatesan²,

Jain³

et al. 2023

ORR

View full text Add to dashboard Cite

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“…2 Commonly defined as a partial pressure of oxygen (PaO2) >100mmHg or oxygen saturation (SpO2) >96%, the use of hyperoxia remains controversial. [3][4][5][6] Potential benefits of hyperoxia include ischemic-preconditioning 7 and enhanced neutrophil oxidative killing function. 8 However, hyperoxia may also lead to harmful consequences following cardiac surgery, including initiating an inflammatory cytokine cascade, 9 reactive oxygen species (ROS) formation, 10 ischemiareperfusion injury, 11 and decreased postoperative PaO2: FiO2 ratio.…”

Section: Oxygenation Targets In Cardiac Surgery: Finding the Sweet Spotmentioning

confidence: 99%

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Smoroda

Douin

Morabito

et al. 2022

Semin Cardiothorac Vasc Anesth

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In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: “cardiac anesthesiology and outcomes” (n = 177), “cardiothoracic anesthesiology” (n = 34), “cardiac anesthesia,” and “clinical outcomes” (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.

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“…7,8,10,11 Our group has demonstrated that hyperoxia is both common and associated with a greater risk for mortality in critically ill trauma patients. 12 The effects of hyperoxia in TBI patients, however, remain controversial. Recent studies have yielded conflicting conclusions.…”

Section: Introductionmentioning

confidence: 99%

Hyperoxia is associated with a greater risk for mortality in critically ill traumatic brain injury patients than in critically ill trauma patients without brain injury

et al. 2023

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Objective: The role of hyperoxia in patients with traumatic brain injury (TBI) remains controversial. The objective of this study was to determine the association between hyperoxia and mortality in critically ill TBI patients compared to critically ill trauma patients without TBI. Design: Secondary analysis of a multicenter retrospective cohort study. Setting: Three regional trauma centers in Colorado, USA, between October 1, 2015, and June 30, 2018. Patients: We included 3464 critically injured adults who were admitted to an intensive care unit (ICU) within 24 h of arrival and qualified for inclusion into the state trauma registry. We analyzed all available SpO2 values during the first seven ICU days. The primary outcome was in-hospital mortality. Secondary outcomes included the proportion of time spent in hyperoxia (defined as SpO2 > 96%) and ventilator-free days. Interventions: None. Measurements and Main Results: In-hospital mortality occurred in 163 patients (10.7%) in the TBI group and 101 patients (5.2%) in the non-TBI group. After adjusting for ICU length of stay, TBI patients spent a significantly greater amount of time in hyperoxia versus non-TBI patients ( p = 0.024). TBI status significantly modified the effect of hyperoxia on mortality. At each specific SpO2 level, the risk of mortality increases with increasing FiO2 for both patients with and without TBI. This trend was more pronounced at lower FiO2 and higher SpO2 values, where a greater number of patient observations were obtained. Among patients who required invasive mechanical ventilation, TBI patients required significantly more days of ventilation to day 28 than non-TBI patients. Conclusions: Critically ill trauma patients with a TBI spend a greater proportion of time in hyperoxia compared to those without a TBI. TBI status significantly modified the effect of hyperoxia on mortality. Prospective clinical trials are needed to better assess a possible causal relationship.

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Association Between Hyperoxia, Supplemental Oxygen, and Mortality in Critically Injured Patients

Abstract: Supplemental Digital Content is available in the text.

Cited by 15 publications

References 53 publications

Risks in the Management of Polytrauma Patients: Clinical Insights

Risks in the Management of Polytrauma Patients: Clinical Insights

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Hyperoxia is associated with a greater risk for mortality in critically ill traumatic brain injury patients than in critically ill trauma patients without brain injury

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