Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study

Abstract

Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods:In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO 2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO 2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO 2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO 2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO 2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO 2 . Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO 2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO 2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO 2 55-100 mmHg) patients (P = 0.47).Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

Investigating Disturbances of Oxygen Homeostasis: From Cellular Mechanisms to the Clinical Practice

“…A sub-study from the epidemiological LUNG SAFE study (from 2016) assessed the association of hyperoxemia (on admission or sustained) and excessive oxygen use in early ARDS. In this cohort study, no relationship could be found to worse outcome in regard to hypoxemia and high FiO 2 ( Madotto et al, 2020 ). Generally, hyperoxia (and mild hyperoxia) aggravate and synergistically worsen VILI phenomenons such as an increase in pulmonary permeability and edema formation, decreased surfactant and lung compliance, and an increase in inflammatory markers and apoptosis ( Kallet and Branson, 2016 ) (and references therein).…”

Oxygen Management During Collective Aeromedical Evacuation of 36 COVID-19 Patients With ARDS

“…Oxygen targets and the risk of hyperoxemia are emerging issues in critically ill patients. 17 , 18 To the best of our knowledge, neither incidence nor impact of hyperoxemia during interhospital transfers has been explored. Based on our experience, it is hard to be in strict compliance with strict oxygenation targets during medevac flights, and the risk-to-benefit ratio may favor the prevention of hypoxemia in this context.…”

Pulmonary infections complicating ARDS

“…Hyperoxia is common in patients receiving MV for ARDS. A secondary analysis of the LUNG SAFE trial [ 32 ] reported that 30% of the 2005 analyzed patients had hyperoxia on day 1, and 12% had sustained hyperoxia. While two randomized controlled trials found beneficial effect of avoiding hyperoxia [ 33 , 34 ], a recent large international multicenter trial demonstrated no effect of conservative oxygen therapy in a cohort of critically ill patients [ 35 ].…”