Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry
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RESEARCH
Open Access
Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry Josefine S. Baekgaard1,2* , Paer-Selim Abback3, Marouane Boubaya4, Jean-Denis Moyer3, Delphine Garrigue5, Mathieu Raux6, Benoit Champigneulle7, Guillaume Dubreuil8, Julien Pottecher9, Philippe Laitselart10, Fleur Laloum11, Coralie Bloch-Queyrat4, Frédéric Adnet1, Catherine Paugam-Burtz3 and Traumabase® Study Group
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. Keywords: Hyperoxemia, Hyperoxia, Trauma, Critical care, Oxygen * Correspondence: [email protected] 1 Urgences et Samu 93, AP-HP, Avicenne Hospital, Inserm U942, 93000 Bobigny, France 2 Department of Anesthesia, Section 4231, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Juliane Maries Vej 10, DK-2100 Copenhagen, Denmark Full list of author information is available at the end of the article © The Author(s). 2020 Open Ac
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