Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality

Abstract

Background Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no studies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO2) reduces the rate of surgical-wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO2 is associated with risk of death in adult patients with sepsis/septic shock after major surgery. Methods We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO2 > 100 mmHg (n = 216), or PaO2 ≤ 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS-3 criteria maintained during 48 h. Primary end-point was 90-day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation. Results In patients with PaO2 ≤ 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days, p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90-day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90-day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39–0.95, p = 0.029), independent of age, chronic renal failure, procalcitonin levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded. Conclusions Oxygenation with a PaO2 above 100 mmHg was independently associated with lower 90-day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO2 in postsurgical patients with severe infections.

Time-varying intensity of oxygen exposure is associated with mortality in critically ill patients with mechanical ventilation

“…PaO 2 and FiO 2 outside the normal physiological range can be detrimental and exacerbate systemic organ injury in critically ill patients [2][3][4][5], while numerous studies provided conflicting evidence concerning the impact of PaO 2 and FiO 2 on clinical outcomes of critically ill patients [6][7][8][9][10]. The cut-off values of PaO 2 and FiO 2 associated with increased risk of death were various, and still uncertain.…”

Reply to “Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality”

“…We would like to express our gratitude for the great interest generated by our article [ 1 ]. We would kindly like to clarify certain points in order to facilitate and stimulate scientific discussion.…”

“…The potential association between PaO 2 levels and risk of 90-day mortality was further evaluated by using a multivariate logistic regression analysis. Using the variables in Table 1 [ 1 ], a univariate regression analysis was performed for 90-day mortality in order to select the confounding factors for the multivariate analysis. Variables showing a p value < 0.1 with no collinearity were included as adjustment variables in the multivariate analysis.…”

Ibrutinib Prevents Acute Lung Injury via Multi-Targeting BTK, FLT3 and EGFR in Mice

“…Severe sepsis and septic shock are lethal complications of bacterial infections [ 23 , 24 ] that can cause ALI and ARDS. The most common pathogenic bacteria are Gram-positive bacteria ( Staphylococcus aureus ) and Gram-negative bacteria ( Escherichia coli and Pseudomonas aeruginosa ).…”