Hyperoxemia as a risk factor for ventilator-associated pneumonia

Six, Sophie; Jaffal, Karim; Ledoux, G.; Jaillette, Emmanuelle; Wallet, Frédéric; Nseir, Saad

doi:10.1186/s13054-016-1368-4

Cited by 75 publications

(77 citation statements)

References 43 publications

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“…Number of days spent with hyperoxaemia has been shown as an independent risk factor for ventilator associated pneumonia, 13 Number of days spent with hyperoxaemia has been shown as an independent risk factor for ventilator associated pneumonia, 13 …”

Section: Discussionmentioning

confidence: 99%

“…The median Injury Severity Score (ISS) was 10 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and the first recorded Glasgow Coma Scale (GCS) score in the trauma bay was 13 [3][4][5][6][7][8][9][10][11][12][13][14][15] (Table 1).…”

Section: Re Sultsmentioning

confidence: 99%

“…10 Of note, the only trial on trauma patients (traumatic brain injury [TBI]) that was included did not report mortality data but, conversely, showed that degree of disability was significantly higher at 6 months in the group that had received restrictive oxygen compared to liberal oxygen. 12,13 For example, a recent retrospective study found hyperoxaemia to be an independent risk factor for ventilator associated pneumonia. 12,13 For example, a recent retrospective study found hyperoxaemia to be an independent risk factor for ventilator associated pneumonia.…”

Section: Introductionmentioning

confidence: 99%

“…11 In addition to mortality, hyperoxaemia has been associated with major pulmonary complications in the Intensive Care Unit (ICU) as well as in surgical patients. 13 Nevertheless, a highly debated recommendation from the World Health Organisation strongly recommends adult patients undergoing general anaesthesia for surgical procedures receive a FiO 2 of 80% intraoperatively as well as in the immediate post-operative period for 2-6 hours to reduce the risk of surgical site infections. 13 Nevertheless, a highly debated recommendation from the World Health Organisation strongly recommends adult patients undergoing general anaesthesia for surgical procedures receive a FiO 2 of 80% intraoperatively as well as in the immediate post-operative period for 2-6 hours to reduce the risk of surgical site infections.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Restrictive vs liberal oxygen for trauma patients‐the TRAUMOX1 pilot randomised clinical trial

Baekgaard

Isbye

Ottosen

et al. 2019

Acta Anaesthesiol Scand

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Introduction:Hyperoxaemia is commonly observed in trauma patients but has been associated with pulmonary complications and mortality in some patient populations.The objectives of this study were to evaluate whether maintenance of normoxia is feasible using a restrictive oxygen strategy in the initial phase after trauma and to evaluate the incidence of 30-day mortality and/or major pulmonary complications. Methods: Forty-one adult trauma patients admitted to our trauma centre were randomised to 24 hours of restrictive oxygen therapy (no supplemental oxygen if the arterial oxyhaemoglobin saturation (SpO 2 ) was at least 94%, n = 21) or liberal oxygen therapy (intubated patients: FiO 2 1.0 in the trauma bay, 0.8-1.0 elsewhere; spontaneously breathing patients: 15 L/min via a non-rebreather mask, n = 20). Two blinded anaesthesiologists evaluated major in-hospital pulmonary complications within 30 days. Results: Protocol compliance was high, as the median arterial oxygen tension was significantly lower in the restrictive group (10.8 kPa [9.7-12.0] vs 30.4 kPa [23.7-39.0], P < 0.0001). There were seven episodes of SpO 2 below 90% in the restrictive group and one episode in the liberal group. Thirty-day mortality and/or major in-hospital pulmonary complications occurred in 4/20 (20%) in the restrictive group and in 6/18 (33%) in the liberal group: two patients in each group died within 30 days and the incidence of major in-hospital pulmonary complications was 2/20 (10%) in the restrictive group and 4/18 (22%) in the liberal group.Conclusion: Maintenance of normoxia using a restrictive oxygen strategy following trauma is feasible. This pilot study serves as the basis for a larger clinical trial.

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Section: Discussionmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Restrictive vs liberal oxygen for trauma patients‐the TRAUMOX1 pilot randomised clinical trial

Baekgaard

Isbye

Ottosen

et al. 2019

Acta Anaesthesiol Scand

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“…Our group performed a large single center cohort study to determine the relationship between hyperoxemia and VAP (50 Other multiple regression models also identified hyperoxemia at ICU admission (OR =1.89, 95% CI: 1.23-2.89, P= 0.004), and percentage of days with hyperoxemia (OR =2.2, 95% CI: 1.08-4.48, P=0.029) as independent risk factors for VAP. However, the study was retrospective, performed in a single center, and the definition used for hyperoxemia (at least one PaO 2 value >120 mmHg per day) could be a matter for debate.…”

Section: Clinical Studiesmentioning

confidence: 99%

Relationship between hyperoxemia and ventilator associated pneumonia

et al. 2017

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Previous studies suggest a relationship between hyperoxemia and ventilator-associated pneumonia (VAP). Hyperoxemia is responsible for denitrogenation phenomena, and inhibition of surfactant production, promoting atelectasis in mechanically ventilated patients. Further, hyperoxemia impairs the efficacy of alveolar macrophages to migrate, phagocyte and kill bacteria. Oxygen can also cause pulmonaryspecific toxic effect called hyperoxic acute lung injury leading to longer duration of mechanical ventilation.All these hyperoxic effects are well-known risk factors for VAP. A recent retrospective large single center study identified hyperoxemia as an independent risk factor for VAP. However, two recent randomized controlled trials evaluated the impact of conservative oxygen strategy versus a liberal strategy, but did not confirm the role of hyperoxemia in lower respiratory tract infection occurrence. In this review, we discuss animal and human studies suggesting a relationship between these two common conditions in mechanically ventilated patients and potential interventions that should be evaluated. Further large prospective studies in carefully selected groups of patients are required to confirm the potential role of hyperoxemia in VAP pathogenesis and to evaluate the impact of a conservative oxygen strategy vs. a conventional strategy on the incidence of VAP.

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Early Restrictive vs Liberal Oxygen for Trauma Patients

Arleth,

Baekgaard,

Siersma

et al. 2024

JAMA

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ImportanceEarly administration of supplemental oxygen for all severely injured trauma patients is recommended, but liberal oxygen treatment has been associated with increased risk of death and respiratory complications.ObjectiveTo determine whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy in adult trauma patients would reduce death and/or major respiratory complications.Design, Setting, and ParticipantsThis randomized controlled trial enrolled adult trauma patients transferred directly to hospitals, triggering a full trauma team activation with an anticipated hospital stay of a minimum of 24 hours from December 7, 2021, to September 12, 2023. This multicenter trial was conducted at 15 prehospital bases and 5 major trauma centers in Denmark, the Netherlands, and Switzerland. The 30-day follow-up period ended on October 12, 2023. The primary outcome was assessed by medical specialists in anesthesia and intensive care medicine blinded to the randomization.InterventionsIn the prehospital setting or on trauma center admission, patients were randomly assigned 1:1 to a restrictive oxygen strategy (arterial oxygen saturation target of 94%) (n = 733) or liberal oxygen strategy (12-15 L of oxygen per minute or fraction of inspired oxygen of 0.6-1.0) (n = 724) for 8 hours.Main Outcomes and MeasuresThe primary outcome was a composite of death and/or major respiratory complications within 30 days. The 2 key secondary outcomes, death and major respiratory complications within 30 days, were assessed individually.ResultsAmong 1979 randomized patients, 1508 completed the trial (median [IQR] age, 50 [31-65] years; 73% male; and median Injury Severity Score was 14 [9-22]). Death and/or major respiratory complications within 30 days occurred in 118 of 733 patients (16.1%) in the restrictive oxygen group and 121 of 724 patients (16.7%) in the liberal oxygen group (odds ratio, 1.01 [95% CI, 0.75 to 1.37]; P = .94; absolute difference, 0.56 percentage points [95% CI, −2.70 to 3.82]). No significant differences were found between groups for each component of the composite outcome. Adverse and serious adverse events were similar across groups, with the exception of atelectasis, which was less common in the restrictive oxygen group compared with the liberal oxygen group (27.6% vs 34.7%, respectively).Conclusions and RelevanceIn adult trauma patients, an early restrictive oxygen strategy compared with a liberal oxygen strategy initiated in the prehospital setting or on trauma center admission for 8 hours did not significantly reduce death and/or major respiratory complications within 30 days.Trial RegistrationClinicalTrials.gov Identifier: NCT05146700

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Hyperoxemia as a risk factor for ventilator-associated pneumonia

Cited by 75 publications

References 43 publications

Restrictive vs liberal oxygen for trauma patients‐the TRAUMOX1 pilot randomised clinical trial

Restrictive vs liberal oxygen for trauma patients‐the TRAUMOX1 pilot randomised clinical trial

Relationship between hyperoxemia and ventilator associated pneumonia

Early Restrictive vs Liberal Oxygen for Trauma Patients

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