Catalano Jackson, Savage Simon, Olaussen Alexander, Gantner Dashiell, Mitra Biswadev
Emergency & Trauma Centre, Alfred Health, 55 Commercial Rd, Melbourne VIC 3004, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia.
School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia.
J Clin Neurosci. 2025 Jan;131:110939. doi: 10.1016/j.jocn.2024.110939. Epub 2024 Nov 30.
It is common practice to administer oxygen to neurocritical patients in the Intensive Care Unit (ICU). Consequent hyperoxia has been associated with unfavourable outcomes including in patients with brain injury, after cardiac arrest, sepsis, and traumatic brain injury. The aim of this systematic review was to explore the association between hyperoxia exposure and unfavourable outcome in patients following a non-traumatic subarachnoid haemorrhage (SAH).
Systematic searches of Medline, Embase, Emcare, CINAHL and PubMed were performed in February 2024 using key words for SAH and hyperoxia. Non-human studies, articles in languages other than English, studies that did not measure blood oxygenation levels via pulse oximetry or arterial blood gas analyses, and studies exploring traumatic SAH were excluded. The Newcastle-Ottawa Risk of Bias tool (NOS) was used to assess the quality of included manuscripts. The primary outcome was a composite outcome combining mortality or poor functional neurological outcome. Secondary outcomes included mortality, poor functional neurological outcome, and development of delayed cerebral ischaemia (DCI).
The literature search yielded 1,219 non-duplicate articles published after 1 January 2000, of which 21 articles were reviewed as full-texts and nine were included in this review. All included studies were rated good/high quality using the NOS. Hyperoxia exposure was associated with increased risk of adverse composite outcome of death or unfavourable functional neurological outcome (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.19-2.16), poor functional neurological outcome alone (OR 1.79, 95% CI 1.33-2.42) and development of DCI (OR 2.63, 95% CI 1.79-3.85). The association of hyperoxia and hospital mortality alone was not statistically significant (OR 1.42, 95% CI 0.98-2.04).
Hyperoxia may contribute to unfavourable outcomes and the development of DCI after an non-traumatic SAH. Trials using restrictive oxygen therapy among patients with SAH are indicated.
在重症监护病房（ICU）对神经重症患者给予氧气治疗是常见的做法。随之而来的高氧血症与不良后果相关，包括脑损伤患者、心脏骤停后患者、脓毒症患者和创伤性脑损伤患者。本系统评价的目的是探讨非创伤性蛛网膜下腔出血（SAH）患者高氧暴露与不良后果之间的关联。
2024年2月，使用SAH和高氧血症的关键词对Medline、Embase、Emcare、CINAHL和PubMed进行系统检索。排除非人研究、非英文文章、未通过脉搏血氧饱和度测定或动脉血气分析测量血氧水平的研究以及探索创伤性SAH的研究。使用纽卡斯尔-渥太华偏倚风险工具（NOS）评估纳入手稿的质量。主要结局是将死亡率或不良功能神经结局合并的复合结局。次要结局包括死亡率、不良功能神经结局和迟发性脑缺血（DCI）的发生。
文献检索产生了2000年1月1日之后发表的1219篇非重复文章，其中21篇文章作为全文进行了审查，9篇纳入了本评价。使用NOS对所有纳入研究的质量评定为良好/高质量。高氧暴露与死亡或不良功能神经结局的不良复合结局风险增加相关（比值比（OR）1.61，95%置信区间（CI）1.19-2.16），单独的不良功能神经结局（OR 1.79，95%CI 1.33-2.42）和DCI的发生（OR 2.63，95%CI 1.79-3.85）。高氧血症与单独的医院死亡率之间的关联无统计学意义（OR 1.42，95%CI 0.9
