Abstract
BackgroundHyperoxemia 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.MethodsUsing 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).ResultsA 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).ConclusionIn 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.
Highlights
Each year, 5.8 million people die as result of trauma making it the leading cause of death for individuals below 45 years of age [1]
Of 6654 adult trauma patients with Arterial oxygen partial pressure (PaO2) values available in the database, 544 were excluded as they were withdrawn from life-sustaining therapy and 462 were excluded as they were hypoxemic on arrival, leaving 5912 patients for analysis (Fig. 1)
Numerous baseline characteristics were significantly different between normoxemic and hyperoxemic patients: a higher proportion of hyperoxemic patients were mechanically ventilated, they had lower prehospital Glasgow Coma Scale (GCS) scores and more suffered from a traumatic brain injury (TBI)
Summary
5.8 million people die as result of trauma making it the leading cause of death for individuals below 45 years of age [1]. The prehospital management of severe trauma patients requires a rapid approach during which it is recommended to provide supplemental oxygen to both treat and prevent hypoxemia [3, 4]. High fractions of inspired oxygen (FiO2) are commonly administered during this initial phase and may result in hyperoxemia on hospital admission. 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
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