Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study

Authors: David Page, Enyo Ablordeppey, Brian T. Wessman, Nicholas M. Mohr, Stephen Trzeciak, Marin H. Kollef, Brian W. Roberts, Brian M. Fuller

Published in: Critical Care | Issue 1/2018

Login to get access

Abstract

Background

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).

Methods

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).

Results

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)).

Conclusions

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.
Appendix
Available only for authorised users
Literature
1.
O'driscoll B, Howard L, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72 Suppl 1:ii1–ii90.CrossRefPubMed
2.
de Graaff AE, Dongelmans DA, Binnekade JM, de Jonge E. Clinicians’ response to hyperoxia in ventilated patients in a Dutch ICU depends on the level of FiO2. Intensive Care Med. 2011;37(1):46–51.CrossRefPubMed
3.
Helmerhorst HJ, Schultz MJ, van der Voort PH, Bosman RJ, Juffermans NP, de Jonge E, van Westerloo DJ. Self-reported attitudes versus actual practice of oxygen therapy by ICU physicians and nurses. Ann Intensive Care. 2014;4(1):23.CrossRefPubMedPubMedCentral
4.
Suzuki S, Eastwood GM, Peck L, Glassford NJ, Bellomo R. Current oxygen management in mechanically ventilated patients: a prospective observational cohort study. J Crit Care. 2013;28(5):647–54.CrossRefPubMed
5.
Damiani E, Adrario E, Girardis M, Romano R, Pelaia P, Singer M, Donati A. Arterial hyperoxia and mortality in critically ill patients: a systematic review and meta-analysis. Crit Care. 2014;18(6):711.CrossRefPubMedPubMedCentral
6.
Helmerhorst HJ, Roos-Blom M-J, van Westerloo DJ, de Jonge E. Association between arterial hyperoxia and outcome in subsets of critical illness: a systematic review, meta-analysis, and meta-regression of cohort studies. Crit Care Med. 2015;43(7):1508–19.CrossRefPubMed
7.
Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ. Air versus oxygen in ST-segment elevation myocardial infarction. Circulation. 2015;131(24):2143–50.CrossRefPubMed
8.
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
9.
Helmerhorst HJ, Arts DL, Schultz MJ, van der Voort PH, Abu-Hanna A, de Jonge E, van Westerloo DJ. Metrics of arterial hyperoxia and associated outcomes in critical care. Crit Care Med. 2017;45(2):187–95.CrossRefPubMed
10.
Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter K, Parrillo JE, Trzeciak S, Investigators EMSRN. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010;303(21):2165–71.CrossRefPubMed
11.
Rincon F, Kang J, Maltenfort M, Vibbert M, Urtecho J, Athar MK, Jallo J, Pineda CC, Tzeng D, McBride W. Association between hyperoxia and mortality after stroke: a multicenter cohort study. Crit Care Med. 2014;42(2):387–96.CrossRefPubMed
12.
Janz DR, Hollenbeck RD, Pollock JS, McPherson JA, Rice TW. Hyperoxia is associated with increased mortality in patients treated with mild therapeutic hypothermia after sudden cardiac arrest. Crit Care Med. 2012;40(12):3135.CrossRefPubMedPubMedCentral
13.
Kilgannon JH, Jones AE, Parrillo JE, Dellinger RP, Milcarek B, Hunter K, Shapiro NI, Trzeciak S. Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation. 2011;123(23):2717–22.CrossRefPubMed
14.
Brenner M, Stein D, Hu P, Kufera J, Wooford M, Scalea T. Association between early hyperoxia and worse outcomes after traumatic brain injury. Arch Surg. 2012;147(11):1042–6.CrossRefPubMed
15.
Davis DP, Meade Jr W, Sise MJ, Kennedy F, Simon F, Tominaga G, Steele J, Coimbra R. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma. 2009;26(12):2217–23.CrossRefPubMed
16.
Rincon F, Kang J, Vibbert M, Urtecho J, Athar MK, Jallo J. Significance of arterial hyperoxia and relationship with case fatality in traumatic brain injury: a multicentre cohort study. J Neurol Neurosurg Psychiatry. 2014;85(7):799–805.CrossRefPubMed
17.
Andrade P, Dos Santos J, Silva A, Wilbert D, Cavassani S, Oliveira-Junior I. Influence of hyperoxia and mechanical ventilation in lung inflammation and diaphragm function in aged versus adult rats. Inflammation. 2014;37(2):486.CrossRefPubMed
18.
Cavassani SS, Junqueira VBC, Moraes JB, Luzo KK, Silva CMA, Barros M, Marinho M, Simões RS, Oliveira-Júnior IS. Short courses of mechanical ventilation with high-O2 levels in elderly rat lungs. Acta Cir Bras. 2011;26(2):107–13.CrossRefPubMed
19.
Li L-F, Liao S-K, Ko Y-S, Lee C-H, Quinn DA. Hyperoxia increases ventilator-induced lung injury via mitogen-activated protein kinases: a prospective, controlled animal experiment. Crit Care. 2007;11(1):R25.CrossRefPubMedPubMedCentral
20.
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
21.
Fuller BM, Mohr NM, Dettmer M, Kennedy S, Cullison K, Bavolek R, Rathert N, McCammon C. Mechanical ventilation and acute lung injury in emergency department patients with severe sepsis and septic shock: an observational study. Acad Emerg Med. 2013;20(7):659–69.CrossRefPubMedPubMedCentral
22.
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
23.
Rose L, Gray S, Burns K, Atzema C, Kiss A, Worster A, Scales DC, Rubenfeld G, Lee J. Emergency department length of stay for patients requiring mechanical ventilation: a prospective observational stud. Scand J Trauma Resusc Emerg Med. 2012;20(1):30.CrossRefPubMedPubMedCentral
24.
Fuller BM, Ferguson IT, Mohr NM, Drewry AM, Palmer C, Wessman BT, Ablordeppey E, Keeperman J, Stephens RJ, Briscoe CC. Lung-protective ventilation initiated in the emergency department (LOV-ED): a quasi-experimental, before-after trial. Ann Emerg Med. 2017;70(3):406–18.CrossRefPubMed
25.
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
26.
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.
27.
Eastwood G, Bellomo R, Bailey M, Taori G, Pilcher D, Young P, Beasley R. Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Med. 2012;38(1):91–8.CrossRefPubMed
28.
Stolmeijer R, ter Maaten JC, Zijlstra JG, Ligtenberg JJ. Oxygen therapy for sepsis patients in the emergency department: a little less? Eur J Emerg Med. 2014;21(3):233–5.CrossRefPubMed
29.
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
30.
31.
Iscoe S, Fisher JA. Hyperoxia-induced hypocapnia*: an underappreciated risk. Chest. 2005;128(1):430.CrossRefPubMed
32.
Girardis M, Busani S, Damiani E, Donati A, Rinaldi L, Marudi A, Morelli A, Antonelli M, Singer M. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA. 2016;316(15):1583–9.CrossRefPubMed
33.
Panwar R, Hardie M, Bellomo R, Barrot L, Eastwood GM, Young PJ, Capellier G, Harrigan PW, Bailey M. Conservative versus liberal oxygenation targets for mechanically ventilated patients. A pilot multicenter randomized controlled trial. Am J Respir Crit Care Med. 2016;193(1):43–51.CrossRefPubMed
Metadata
Title
Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study
Authors
David Page
Enyo Ablordeppey
Brian T. Wessman
Nicholas M. Mohr
Stephen Trzeciak
Marin H. Kollef
Brian W. Roberts
Brian M. Fuller
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1926-4

Other articles of this Issue 1/2018

Critical Care 1/2018 Go to the issue

Research

Delirium prediction in the intensive care unit: comparison of two delirium prediction models

Research

Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study

Viewpoint

High protein intake during the early phase of critical illness: yes or no?

Review

Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation

Research

Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Research

Resuscitative endovascular balloon occlusion of the aorta performed by emergency physicians for traumatic hemorrhagic shock: a case series from Japanese emergency rooms