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Wu H, Gong L, Gu JC, Xing HW, Qian ZX, Mao Q. Proper Partial Pressure of Arterial Oxygen for Patients with Traumatic Brain Injury. Med Sci Monit 2021; 27:e932318. [PMID: 34663780 PMCID: PMC8540035 DOI: 10.12659/msm.932318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The partial pressure of arterial oxygen (PaO2) is critical to the outcome of patients with traumatic brain injury (TBI). However, it is not clear what range of PaO2 should be maintained to improve patient outcome. The aim of this study was to explore the PaO2 value needed in the acute phase of TBI and provide new evidence for clinical practice. Material/Methods A total of 153 patients with TBI were enrolled retrospectively. Univariate and multivariate logistic regression analyses were conducted on sex, Glasgow Coma Scale (GCS) score on admission, PaO2 within 6 h of admission, oxygenation index, and other factors. The Glasgow Outcome Score (GOS) of the patient at discharge was used as an indicator of outcome. The good outcome group had GOS ≥4, and the poor outcome group had GOS <4. Results The 153 patients were divided into a good outcome group (n=62) and poor outcome group (n=91). There was a significant difference in sex, admission GCS, surgery, airway status, PaO2, and oxygen index within 6 h of admission between the 2 groups. Logistic regression analysis showed that PaO2 <60 mmHg, male sex, and admission GCS score of 3 to 12 were independent risk factors for a poor outcome. Conclusions Patients with TBI having PaO2 <60 mmHg within 6 h after admission were more likely to have poor outcomes. The upper limit value of PaO2 that affects the outcome of TBI in patients has not been found.
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Affiliation(s)
- Hong Wu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Liang Gong
- Department of Neurosurgery, Punan Hospital, Shanghai, China (mainland)
| | - Jia-Cheng Gu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
| | - Hong-Wei Xing
- Department of Neurosurgery, Linquan County People's Hospital, Fuyang, Anhui, China (mainland)
| | - Zhong-Xin Qian
- Department of Neurosurgery, Punan Hospital, Shanghai, China (mainland)
| | - Qing Mao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)
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Baekgaard JS, Abback PS, Boubaya M, Moyer JD, Garrigue D, Raux M, Champigneulle B, Dubreuil G, Pottecher J, Laitselart P, Laloum F, Bloch-Queyrat C, Adnet F, Paugam-Burtz C. Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry. Crit Care 2020; 24:604. [PMID: 33046127 PMCID: PMC7549241 DOI: 10.1186/s13054-020-03274-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hyperoxemia has been associated with increased mortality in critically ill patients, but little is known about its effect in trauma patients. The objective of this study was to assess the association between early hyperoxemia and in-hospital mortality after severe trauma. We hypothesized that a PaO2 ≥ 150 mmHg on admission was associated with increased in-hospital mortality. METHODS Using data issued from a multicenter prospective trauma registry in France, we included trauma patients managed by the emergency medical services between May 2016 and March 2019 and admitted to a level I trauma center. Early hyperoxemia was defined as an arterial oxygen tension (PaO2) above 150 mmHg measured on hospital admission. In-hospital mortality was compared between normoxemic (150 > PaO2 ≥ 60 mmHg) and hyperoxemic patients using a propensity-score model with predetermined variables (gender, age, prehospital heart rate and systolic blood pressure, temperature, hemoglobin and arterial lactate, use of mechanical ventilation, presence of traumatic brain injury (TBI), initial Glasgow Coma Scale score, Injury Severity Score (ISS), American Society of Anesthesiologists physical health class > I, and presence of hemorrhagic shock). RESULTS A total of 5912 patients were analyzed. The median age was 39 [26-55] years and 78% were male. More than half (53%) of the patients had an ISS above 15, and 32% had traumatic brain injury. On univariate analysis, the in-hospital mortality was higher in hyperoxemic patients compared to normoxemic patients (12% versus 9%, p < 0.0001). However, after propensity score matching, we found a significantly lower in-hospital mortality in hyperoxemic patients compared to normoxemic patients (OR 0.59 [0.50-0.70], p < 0.0001). CONCLUSION In this large observational study, early hyperoxemia in trauma patients was associated with reduced adjusted in-hospital mortality. This result contrasts the unadjusted in-hospital mortality as well as numerous other findings reported in acutely and critically ill patients. The study calls for a randomized clinical trial to further investigate this association.
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Affiliation(s)
- Josefine S. Baekgaard
- Urgences et Samu 93, AP-HP, Avicenne Hospital, Inserm U942, 93000 Bobigny, France
- Department of Anesthesia, Section 4231, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100 Copenhagen, Denmark
| | - Paer-Selim Abback
- Department of Anesthesia and Critical Care, Beaujon Hospital, AP-HP, University of Paris, Paris, France
| | | | - Jean-Denis Moyer
- Department of Anesthesia and Critical Care, Beaujon Hospital, AP-HP, University of Paris, Paris, France
| | - Delphine Garrigue
- Department of Anesthesia and Critical Care, CHU de Lille, Lille, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d’Anesthésie Réanimation, F-75013 Paris, France
| | - Benoit Champigneulle
- Surgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Guillaume Dubreuil
- Department of Anesthesia and Critical Care, AP-HP, Bicêtre Hospital, Paris, France
| | - Julien Pottecher
- Department of Anesthesia and Surgical Critical Care, Strasbourg University Hospital, Strasbourg, France
| | | | - Fleur Laloum
- Department of Anesthesia and Critical Care, University Hospital of Reims, Reims, France
| | | | - Frédéric Adnet
- Urgences et Samu 93, AP-HP, Avicenne Hospital, Inserm U942, 93000 Bobigny, France
| | - Catherine Paugam-Burtz
- Department of Anesthesia and Critical Care, Beaujon Hospital, AP-HP, University of Paris, Paris, France
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