The Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Neurocrit Care. 2018 Dec;29(3):443-451. doi: 10.1007/s12028-018-0553-5.
Early hyperoxia may be an independent risk factor for mortality in critically ill traumatic brain injury (TBI) patients, although current data are inconclusive. Accordingly, we conducted a retrospective cohort study to determine the association between systemic oxygenation and in-hospital mortality, in critically ill mechanically ventilated TBI patients.
Data were extracted from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database. All adult TBI patients receiving mechanical ventilation in 129 intensive care units between 2000 and 2016 were included in analysis. The following data were extracted: demographics, illness severity scores, physiological and laboratory measurements, institutional characteristics, and vital status at discharge. In-hospital mortality was used as the primary study outcome. The primary exposure variable was the 'worst' partial arterial pressure of oxygen (PaO2) recorded during the first 24 h in ICU; hyperoxia was defined as > 299 mmHg. Adjustment for illness severity utilized multivariable logistic regression, the results of which are reported as the odds ratio (OR) 95% CI.
Data concerning 24,148 ventilated TBI patients were extracted. By category of worst PaO2, crude in-hospital mortality ranged from 27.1% (PaO2 40-49 mmHg) to 13.3% (PaO2 140-159 mmHg). When adjusted for patient and institutional characteristics, the only PaO2 category associated with a significantly greater risk of death was < 40 mmHg [OR 1.52, 1.03-2.25]. A total of 3117 (12.9%) patients were hyperoxic during the first 24 h in ICU, with a crude in-hospital mortality rate of 17.8%. No association was evident in between hyperoxia and mortality in adjusted analysis [OR 0.97 (0.86-1.11)].
In this large multicenter cohort of TBI patients, hyperoxia in the first 24 h after ICU admission was not independently associated with greater in-hospital mortality. Hypoxia remains associated with greater in-hospital mortality risk and should be avoided where possible.
早期高氧可能是危重症创伤性脑损伤（TBI）患者死亡的独立危险因素，但目前的数据尚无定论。因此，我们进行了一项回顾性队列研究，以确定危重症机械通气 TBI 患者的全身氧合与院内死亡率之间的关系。
从澳大利亚和新西兰重症监护学会中心的结果和资源评估成人患者数据库中提取数据。纳入分析的所有在 2000 年至 2016 年期间在 129 个重症监护病房接受机械通气的成年 TBI 患者。提取以下数据：人口统计学资料、疾病严重程度评分、生理和实验室测量值、机构特征以及出院时的生命状态。院内死亡率为主要研究结果。主要暴露变量是 ICU 期间记录的最差部分动脉血氧分压（PaO2）；高氧血症定义为> 299mmHg。利用多变量逻辑回归对疾病严重程度进行调整，结果以比值比（OR）95%CI 表示。
提取了 24148 例接受通气 TBI 患者的数据。按最差 PaO2 分类，未调整的院内死亡率范围为 27.1%（PaO2 40-49mmHg）至 13.3%（PaO2 140-159mmHg）。当调整患者和机构特征后，唯一与死亡风险显著增加相关的 PaO2 分类是<40mmHg[OR 1.52，1.03-2.25]。在 ICU 期间，共有 3117 例（12.9%）患者发生高氧血症，院内死亡率为 17.8%。在调整分析中，高氧血症与死亡率之间没有明显的关联[OR 0.97（0.86-1.11）]。
在这项大型多中心 TBI 患者队列研究中，ICU 后 24 小时内的高氧血症与更高的院内死亡率无关。低氧血症仍与更高的院内死亡率风险相关，应尽可能避免。
