Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis

Abstract Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hy...

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Main Authors: P. Leitch, A. L. Hudson, J. E. Griggs, R. Stolmeijer, R. M. Lyon, E. ter Avest, Air Ambulance Kent Surrey Sussex
Format: Article
Language:English
Published: BMC 2021-09-01
Series:Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Subjects:
Online Access:https://doi.org/10.1186/s13049-021-00951-w
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spelling doaj-56f97a04c8b94334b60c47014876949b2021-09-12T11:17:35ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412021-09-012911810.1186/s13049-021-00951-wIncidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysisP. Leitch0A. L. Hudson1J. E. Griggs2R. Stolmeijer3R. M. Lyon4E. ter Avest5Air Ambulance Kent Surrey SussexUniversity of St GeorgesUniversity of St GeorgesAir Ambulance Kent Surrey and SussexDepartment of Emergency Medicine, University Medical Center GroningenAir Ambulance Kent Surrey and SussexAir Ambulance Kent Surrey and SussexAbstract Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients. Methods A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC. Results On arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia. Conclusion Trauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia.https://doi.org/10.1186/s13049-021-00951-wHyperoxiaHyperoxemiaVentilationTraumaEmergency medical servicesOxygen therapy
collection DOAJ
language English
format Article
sources DOAJ
author P. Leitch
A. L. Hudson
J. E. Griggs
R. Stolmeijer
R. M. Lyon
E. ter Avest
Air Ambulance Kent Surrey Sussex
spellingShingle P. Leitch
A. L. Hudson
J. E. Griggs
R. Stolmeijer
R. M. Lyon
E. ter Avest
Air Ambulance Kent Surrey Sussex
Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Hyperoxia
Hyperoxemia
Ventilation
Trauma
Emergency medical services
Oxygen therapy
author_facet P. Leitch
A. L. Hudson
J. E. Griggs
R. Stolmeijer
R. M. Lyon
E. ter Avest
Air Ambulance Kent Surrey Sussex
author_sort P. Leitch
title Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis
title_short Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis
title_full Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis
title_fullStr Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis
title_full_unstemmed Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis
title_sort incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis
publisher BMC
series Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
issn 1757-7241
publishDate 2021-09-01
description Abstract Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients. Methods A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC. Results On arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia. Conclusion Trauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia.
topic Hyperoxia
Hyperoxemia
Ventilation
Trauma
Emergency medical services
Oxygen therapy
url https://doi.org/10.1186/s13049-021-00951-w
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