Providing supplemental oxygen is fundamental in the management of mechanically ventilated patients. Increasing amounts of data show worse clinical outcomes associated with hyperoxia. However, these previous data in the critically ill have not focused on outcomes associated with brief hyperoxia exposure immediately after endotracheal intubation. Therefore, the objectives of this study were to evaluate the impact of isolated early hyperoxia exposure in the emergency department (ED) on clinical outcomes among mechanically ventilated patients with subsequent normoxia in the intensive care unit (ICU).
This was an observational cohort study conducted in the ED and ICUs of an academic center in the USA. Mechanically ventilated normoxic (partial pressure of arterial oxygen (PaO2) 60–120 mm Hg) ICU patients with mechanical ventilation initiated in the ED were studied. The cohort was categorized into three oxygen exposure groups based on PaO2 values obtained after ED intubation: hypoxia, normoxia, and hyperoxia (defined as PaO2 < 60 mmHg, PaO2 60–120 mm Hg, and PaO2 > 120 mm Hg, respectively, based on previous literature).
A total of 688 patients were included. ED normoxia occurred in 350 (50.9%) patients, and 300 (43.6%) had exposure to ED hyperoxia. The ED hyperoxia group had a median (IQR) ED PaO2 of 189 mm Hg (146–249), compared to an ED PaO2 of 88 mm Hg (76–101) in the normoxia group, P < 0.001. Patients with ED hyperoxia had greater hospital mortality (29.7%), when compared to those with normoxia (19.4%) and hypoxia (13.2%). After multivariable logistic regression analysis, ED hyperoxia was an independent predictor of hospital mortality (adjusted OR 1.95 (1.34–2.85)).
ED exposure to hyperoxia is common and associated with increased mortality in mechanically ventilated patients achieving normoxia after admission. This suggests that hyperoxia in the immediate post-intubation period could be particularly injurious, and targeting normoxia from initiation of mechanical ventilation may improve outcome.
Additional file 1: Definitions of comorbid conditions. (DOCX 13 kb)13054_2017_1926_MOESM1_ESM.docx
Additional file 2: Table S1. Ventilator variables during the entire intensive care unit stay. (DOCX 15 kb)13054_2017_1926_MOESM2_ESM.docx
Additional file 3: Table S2. Multivariable logistic regression model with in-hospital mortality as the dependent variable. (DOCX 15 kb)13054_2017_1926_MOESM3_ESM.docx
Additional file 4: Figure S1. Kaplan-Meier survival curve between the hyperoxia subgroups and the normoxia group. (TIFF 76 kb)13054_2017_1926_MOESM4_ESM.tiff
de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, Bosman RJ, de Waal RA, Wesselink R, de Keizer NF. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care. 2008;12(6):R156. CrossRefPubMedPubMedCentral
Helmerhorst HJ, Schouten LR, Wagenaar GT, Juffermans NP, Roelofs JJ, Schultz MJ, de Jonge E, van Westerloo DJ. Hyperoxia provokes a time-and dose-dependent inflammatory response in mechanically ventilated mice, irrespective of tidal volumes. Intensive Care Med Exp. 2017;5(1):27. CrossRefPubMedPubMedCentral
Fuller BM, Mohr NM, Miller CN, Deitchman AR, Levine BJ, Castagno N, Hassebroek EC, Dhedhi A, Scott-Wittenborn N, Grace E. Mechanical ventilation and ARDS in the ED: a multicenter, observational, prospective, cross-sectional study. CHEST J. 2015;148(2):365–74. CrossRef
Fuller BM, Ferguson I, Mohr NM, Stephens RJ, Briscoe CC, Kolomiets AA, Hotchkiss RS, Kollef MH. Lung-protective ventilation initiated in the emergency department (LOV-ED): a study protocol for a quasi-experimental, before-after trial aimed at reducing pulmonary complications. BMJ Open. 2016;6(4):e010991. CrossRefPubMedPubMedCentral
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome. The ARDS definition task force. JAMA. 2012;307(23):2526-33.
Panwar R, Capellier G, Schmutz N, Davies A, Cooper D, Bailey M, Baguley D, Pilcher D, Bellomo R. Current oxygenation practice in ventilated patients-an observational cohort study. Anaesth Intensive Care. 2013;41(4):505. PubMed
- Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study
Brian T. Wessman
Nicholas M. Mohr
Marin H. Kollef
Brian W. Roberts
Brian M. Fuller
- BioMed Central
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