Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry
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 hypo...
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doaj-f02ace1e1c954be8996d4ffc268b66392020-11-25T03:50:45ZengBMCCritical Care1364-85352020-10-0124111110.1186/s13054-020-03274-xEarly hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registryJosefine S. Baekgaard0Paer-Selim Abback1Marouane Boubaya2Jean-Denis Moyer3Delphine Garrigue4Mathieu Raux5Benoit Champigneulle6Guillaume Dubreuil7Julien Pottecher8Philippe Laitselart9Fleur Laloum10Coralie Bloch-Queyrat11Frédéric Adnet12Catherine Paugam-Burtz13Traumabase® Study GroupUrgences et Samu 93, AP-HP, Avicenne Hospital, Inserm U942Department of Anesthesia and Critical Care, Beaujon Hospital, AP-HP, University of ParisURC CRC, Avicenne HospitalDepartment of Anesthesia and Critical Care, Beaujon Hospital, AP-HP, University of ParisDepartment of Anesthesia and Critical Care, CHU de LilleSorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d’Anesthésie RéanimationSurgical Intensive Care Unit, Georges Pompidou European Hospital, AP-HPDepartment of Anesthesia and Critical Care, AP-HP, Bicêtre HospitalDepartment of Anesthesia and Surgical Critical Care, Strasbourg University HospitalDepartment of Anesthesia, Percy Army Training HospitalDepartment of Anesthesia and Critical Care, University Hospital of ReimsURC CRC, Avicenne HospitalUrgences et Samu 93, AP-HP, Avicenne Hospital, Inserm U942Department of Anesthesia and Critical Care, Beaujon Hospital, AP-HP, University of ParisAbstract 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.http://link.springer.com/article/10.1186/s13054-020-03274-xHyperoxemiaHyperoxiaTraumaCritical careOxygen |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Josefine S. Baekgaard Paer-Selim Abback Marouane Boubaya Jean-Denis Moyer Delphine Garrigue Mathieu Raux Benoit Champigneulle Guillaume Dubreuil Julien Pottecher Philippe Laitselart Fleur Laloum Coralie Bloch-Queyrat Frédéric Adnet Catherine Paugam-Burtz Traumabase® Study Group |
spellingShingle |
Josefine S. Baekgaard Paer-Selim Abback Marouane Boubaya Jean-Denis Moyer Delphine Garrigue Mathieu Raux Benoit Champigneulle Guillaume Dubreuil Julien Pottecher Philippe Laitselart Fleur Laloum Coralie Bloch-Queyrat Frédéric Adnet Catherine Paugam-Burtz Traumabase® Study Group Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry Critical Care Hyperoxemia Hyperoxia Trauma Critical care Oxygen |
author_facet |
Josefine S. Baekgaard Paer-Selim Abback Marouane Boubaya Jean-Denis Moyer Delphine Garrigue Mathieu Raux Benoit Champigneulle Guillaume Dubreuil Julien Pottecher Philippe Laitselart Fleur Laloum Coralie Bloch-Queyrat Frédéric Adnet Catherine Paugam-Burtz Traumabase® Study Group |
author_sort |
Josefine S. Baekgaard |
title |
Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry |
title_short |
Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry |
title_full |
Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry |
title_fullStr |
Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry |
title_full_unstemmed |
Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry |
title_sort |
early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a french registry |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2020-10-01 |
description |
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. |
topic |
Hyperoxemia Hyperoxia Trauma Critical care Oxygen |
url |
http://link.springer.com/article/10.1186/s13054-020-03274-x |
work_keys_str_mv |
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