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

Overview

Journal Sci Prog

Publisher Sage Publications

Specialty Science

Date 2023 Mar 7

PMID 36879502

Authors

David J Douin

Layne Dylla

Erin L Anderson

John D Rice

Conner L Jackson

Vikhyat S Bebarta

Robert T Neumann

Steven G Schauer

Adit A Ginde

Affiliations

Soon will be listed here.

Abstract

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 SpO > 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 ( = 0.024). TBI status significantly modified the effect of hyperoxia on mortality. At each specific SpO level, the risk of mortality increases with increasing FiO for both patients with and without TBI. This trend was more pronounced at lower FiO and higher SpO 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.

Citing Articles

Early Restrictive vs Liberal Oxygen for Trauma Patients: The TRAUMOX2 Randomized Clinical Trial.

Arleth T, Baekgaard J, Siersma V, Creutzburg A, Dinesen F, Rosenkrantz O JAMA. 2024; 333(6):479-489.

PMID: 39657224 PMC: 11815523. DOI: 10.1001/jama.2024.25786.

Machine learning-based prediction of clinical outcomes after traumatic brain injury: Hidden information of early physiological time series.

Ding R, Deng M, Wei H, Zhang Y, Wei L, Jiang G CNS Neurosci Ther. 2024; 30(7):e14848.

PMID: 38973193 PMC: 11228354. DOI: 10.1111/cns.14848.

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