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Critical Care
Published in: Critical Care 1/2020

Open Access 01-12-2020 | Central Nervous System Trauma | Research

Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry

Authors: 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

Published in: Critical Care | Issue 1/2020

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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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Metadata
Title
Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry
Authors
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
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03274-x

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