Background
Methods
Study design and participants
Procedures
Statistical analysis
Results
Study population
All subjects n = 688 | ED hypoxiaa n = 38 | ED normoxiab n = 350 | ED hyperoxiac n = 300 | P value | |
---|---|---|---|---|---|
Age (years) | 59.1 (16.0) | 55.0 (16.7) | 60.1 (14.7) | 58.7 (17.1) | 0.024 |
Female gender, n (%) | 290 (42.2) | 15 (39.5) | 166 (47.4) | 106 (35.3) | 0.015 |
Race, n (%) | |||||
Black | 369 (53.6) | 23 (60.5) | 183 (52.3) | 162 (54.0) | 0.661 |
White | 317 (46.1) | 15 (39.5) | 164 (46.9) | 134 (44.7) | |
Other | 7 (1.0) | 0 (0) | 3 (0.9) | 4 (1.3) | |
Comorbidities, n (%) | |||||
Chronic obstructive pulmonary disease | 234 (34.0) | 14 (36.8) | 122 (34.9) | 98 (32.7) | 0.383 |
Malignancy | 117 (17.0) | 8 (21.1) | 57 (16.3) | 52 (17.3) | 0.655 |
Congestive heart failure | 189 (27.5) | 10 (26.3) | 92 (26.3) | 86 (28.7) | 0.893 |
Diabetes mellitus | 252 (36.6) | 19 (50.0) | 125 (35.7) | 107 (35.7) | 0.289 |
End-stage renal disease | 52 (7.6) | 5 (13.2) | 24 (6.9) | 23 (7.7) | 0.498 |
Immunosuppression | 61 (8.9) | 6 (15.8) | 33 (9.4) | 22 (7.3) | 0.287 |
Cirrhosis | 48 (7.0) | 1 (2.6) | 26 (7.4) | 21 (7.0) | 0.660 |
Indication for mechanical ventilation, n (%) | |||||
Asthma | 18 (2.6) | 0 | 8 (2.3) | 10 (3.3) | 0.492 |
Chronic obstructive pulmonary disease | 77 (11.2) | 4 (10.5) | 39 (11.1) | 34 (11.3) | |
CHF/pulmonary edema | 42 (6.1) | 5 (13.2) | 24 (6.9) | 13 (4.3) | |
Sepsis | 237 (34.4) | 17 (44.7) | 117 (33.4) | 102 (34.0) | |
Trauma | 119 (17.3) | 6 (15.8) | 58 (16.6) | 53 (17.7) | |
Cardiac arrest | 42 (6.1) | 1 (2.6) | 17 (4.9) | 24 (8.0) | |
Drug overdose | 29 (4.2) | 1 (2.6) | 13 (3.7) | 15 (5.0) | |
Other | 129 (18.9) | 4 (10.5) | 74 (21.1) | 49 (16.3) | |
APACHE II scored | 16 (12–20) | 19 (14–25) | 16 (12–20) | 15 (11–20) | 0.011 |
Systolic blood pressure (mm Hg) | 117 (94–145) | 105 (75–148) | 117 (97–145) | 118 (95–144) | 0.708 |
Vasopressor infusion, n (%) | 178 (25.9) | 15 (39.5) | 85 (24.3) | 77 (25.7) | 0.238 |
Antibiotic administration, n (%) | 332 (48.3) | 23 (60.5) | 177 (50.6) | 131 (43.7) | 0.068 |
Lactate (mmol/L) | 2.3 (1.5–4.2) | 3.0 (2.0–5.9) | 2.2 (1.4–3.9) | 2.3 (1.5–4.2) | 0.047 |
Hemoglobin (g/dL) | 12.1 (2.6) | 12.1 (2.5) | 12.1 (2.6) | 12.0 (2.7) | 0.335 |
Intravenous fluids in ED (L) | 1.8 (1.8) | 1.7 (1.5) | 1.7 (1.8) | 1.8 (1.8) | 0.969 |
ED LOS (hours) | 5.4 (3.5–7.9) | 5.9 (3.8–8.4) | 5.6 (3.7–8.1) | 5.3 (3.5–7.5) | 0.985 |
Oxygenation and mechanical ventilation characteristics
All subjects n = 688 | ED hypoxiaa n = 38 | ED normoxiab n = 350 | ED hyperoxiac n = 300 | P value | |
---|---|---|---|---|---|
Emergency department | |||||
Tidal volume (mL/kg PBW) | 7.5 (6.4–8.6) | 6.6 (6.1–7.7) | 7.5 (6.4–8.6) | 7.6 (6.7–8.7) | 0.001 |
Respiratory rate | 16 (14–20) | 20 (16–25) | 16 (14–20) | 16 (14–20) | <0.001 |
FiO2 | 70 (47–100) | 60 (40–80) | 68 (40–100) | 80 (50–100) | 0.004 |
PEEP | 5 (5–7) | 8 (5–10) | 5 (5–7) | 5 (5–5) | <0.001 |
pH | 7.29 (7.21–7.38) | 7.26 (7.16–7.33) | 7.29 (7.21–7.38) | 7.29 (7.21–7.39) | 0.354 |
PaO2 (mm Hg) | 110 (82–179) | 54 (51–55) | 88 (76–101) | 189 (146–249) | <0.001 |
PaO2/FiO2 | 192 (115–278) | 106 (83–141) | 129 (92–207) | 270 (198–360) | <0.001 |
Plateau pressure (mmHg) | 20 (17–25) | 24 (20–28) | 20 (17–25) | 20 (17–25) | 0.006 |
Static compliance (mL/cm H20) | 33 (26–45) | 31 (24–36) | 33 (25–45) | 35 (26–46) | 0.071 |
Driving pressure (cm H2O) | 14 (11–19) | 15 (12–18) | 14 (11–19) | 14 (11–19) | 0.117 |
Intensive care unit, day 1 | |||||
Tidal volume (mL/kg PBW) | 8.0 (7.0–8.8) | 7.5 (6.5–8.3) | 8.0 (7.0–9.0) | 7.7 (7.0–8.8) | 0.220 |
FiO2 | 46 (40–60) | 46 (40–57) | 46 (40–60) | 46 (40–60) | 0.616 |
PEEP | 5 (5–6) | 6 (5–8) | 5 (5–6) | 5 (5–6) | 0.002 |
pH | 7.35 (7.29–7.40) | 7.38 (7.30–7.41) | 7.35 (7.29–7.39) | 7.35 (7.29–7.40) | 0.377 |
PaO2 (mm Hg) | 97 (82–113) | 96 (83–113) | 94 (79–109) | 100 (84–117) | 0.002 |
PaO2/FiO2 | 207 (163–258) | 206 (169–244) | 200 (156–257) | 210 (170–260) | 0.053 |
Plateau pressure (mmHg) | 21 (18–25) | 22 (20–25) | 21 (18–25) | 21 (18–25) | 0.266 |
Static compliance (mL/cm H20) | 35 (27–43) | 33 (27–37) | 34 (27–43) | 35 (28–43) | 0.181 |
Driving pressure (cm H2O) | 16 (13–19) | 15 (13–18) | 16 (13–19) | 16 (13–19) | 0.342 |
Clinical outcomes
Outcome | All subjects n = 688 | ED hypoxiaa n = 38 | ED normoxiab n = 350 | ED hyperoxiac n = 300 | Adjusted odds ratio or between-group difference (95% CI) | P value |
---|---|---|---|---|---|---|
Primary outcome, n (%) | ||||||
Mortality | 162 (23.5) | 5 (13.2) | 68 (19.4) | 89 (29.7) | 1.95 (1.34–2.85) | <0.001 |
Secondary outcomes (days) | ||||||
Ventilator-free | 16.5 (10.9) | 20.3 (9.7) | 17.9 (10.3) | 14.2 (11.3) | 3.7 (2.0–5.4) | <0.001 |
ICU-free | 15.2 (10.3) | 17.9 (9.1) | 16.7 (9.8) | 13.2 (10.7) | 3.5 (1.9–5.1) | <0.001 |
Hospital-free | 10.7 (9.2) | 12.8 (9.3) | 11.9 (9.0) | 8.9 (9.1) | 2.9 (1.5–4.3) | <0.001 |