Early Hyperoxia in The Intensive Care Unit is Significantly Associated With Unfavorable Neurological Outcomes in Patients With Mild-to-Moderate Aneurysmal Subarachnoid Hemorrhage

Yokoyama, Shota; Hifumi, Toru; Kawakita, Kenya; Tamiya, Takashi; Minamino, Tetsuo; Kuroda, Yasuhiro

doi:10.1097/shk.0000000000001221

Cited by 24 publications

(26 citation statements)

References 33 publications

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“…On the other hand, a more recently published retrospective cohort study did not find a correlation between hyperoxia and the emergence of a poor neurological fallout (p=0.06). In contrast, in this study, the subgroup of patients with H&K I-III SAH exposed to hyperoxia had an unfavorable neurological prognosis (p=0.02) [10].…”

Section: Discussioncontrasting

confidence: 82%

“…Likewise, the study by Yokoyama et al found no association between a hyperoxic state and the development of ischemic events [10]. However, it is interesting to note that their PaO 2 threshold for defining hyperoxia was <120 mmHg.…”

Section: Discussionmentioning

confidence: 92%

“…Hyperoxia was defined as a PaO 2 value above 120 mmHg like a previous study [8]. We then defined 3 subgroups of hyperoxia i.e., mild (121-200 mmHg), moderate (201-300 mmHg) and severe (>300 mmHg) as previously described, to examine the effect of hyperoxia exposure in mechanically ventilated patient) [10].…”

Section: Definitions Of Hyperoxiamentioning

confidence: 99%

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Association between Early Hyperoxia and Neurologic Outcome in Patient with High Grade Aneurysmal Subarachnoid Hemorrhage

Beaudeux¹,

Kanagaratnam²,

Bard³

et al. 2019

J Neurol Neurosci

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Background: Oxygenation support is a common practice in patients with aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to analyze the association between early hyperoxia and the neurological outcome in patients presenting a High Grade SAH, using the modified Rankin Scale (mRS) at 6 months. Methods: We retrospectively analyzed data of SAH in a single center, retrospective, observational study. The inclusion criteria were patients' ≥ 18 years-old, under mechanical ventilation upon admission to the intensive care unit (ICU) and presenting an aneurysmal SAH with a WFNS score ≥3. Hyperoxia was defined as PaO 2 > 120 mmHg and classified into 3 subgroups: mild (121-200 mmHg), moderate (201-300 mmHg) and severe (> 300 mmHg). Patients with a 6 months-mRS >3 were considered as having a poor outcome. Results: One hundred and thirty-nine patients with aneurysmal SAH were included. 82% of patients were exposed to hyperoxia with predominance of mild hyperoxia (42.8%). A higher yet non-statistical, poor neurologic outcome was identified in the hyperoxic compared to normoxic group (72% vs. 87.7% OR 2.8 [1.02-7.71], p 0.12). Following a multivariate analysis, a statistical trend was identified between the hyperoxic group and a 6-month poor neurological outcome (OR 2.84, 95% CI, 0.99-8.19; p=0.052), but no statistical association was found with delayed cerebral ischemia (OR 1.68, 95% CI, 0.5-5.71, p=0.39) nor with 28-day mortality (OR 2.17, 95% CI, 0.82-5.75, p=0.11). Conclusions: Our findings suggest a statistical trend between early hyperoxia and a poor neurological outcome at 6 months, in patients with a high grade aneurysmal SAH admitted to the ICU. Further, large-scale studies are required to fully evaluate the effects of hyperoxia.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 92%

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Association between Early Hyperoxia and Neurologic Outcome in Patient with High Grade Aneurysmal Subarachnoid Hemorrhage

Beaudeux¹,

Kanagaratnam²,

Bard³

et al. 2019

J Neurol Neurosci

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“…PaO 2 above 300 mm Hg was associated with increased mortality or poor neurological outcome in patients with post‐cardiac arrest resuscitated state or traumatic brain injury, while PaO 2 during cardiac arrest was independently associated with higher rates of survival to hospital discharge or neurological outcome in patients with cardiac arrest . Hyperoxia (PaO 2 > 300 mm Hg) during the first 24 hours in the ICU had no effect on neurological outcome in patients with subarachnoid haemorrhage . However, these data in the critically ill have focused on the outcome associated with relatively prolonged hyperoxia, with the assessment of hyperoxia exposure during the first 24‐72 hours of ICU stay through the entire period of MV.…”

Section: Discussionmentioning

confidence: 99%

Is an increased PaO₂ in a normobaric state safe in acute CO poisoning?

Moon

Chun

Cho

2019

Basic Clin Pharma Tox

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Our objective was to determine how much PaO 2 levels increase after normobaric oxygen (NBO) therapy and whether NBO therapy exerts therapeutic effects regardless of the PaO 2 level. We suggest the optimal PaO 2 level to use during NBO therapy for the acute treatment of carbon monoxide (CO) poisoning. This retrospective study included 311 patients who received oxygen administration after CO poisoning and had a measurable PaO 2 level upon arrival. Baseline characteristics, clinical courses and long-term neurological outcome were collected and compared. The PaO 2 level upon arrival was 192 (161-225) mm Hg, and 272 (87.5%) of the patients presented with hyperoxia. The incidence of poor long-term neurological outcome was 11.3% at a median follow-up period of 35 months. PaO 2 levels upon arrival were higher in patients with good long-term neurological outcome than in those with poor outcome.The incidence of poor long-term neurological outcome was significantly dependent on the PaO 2 level when patients were stratified at 100-mm Hg increments. A multivariate regression analysis showed that PaO 2 levels, when considered a continuous, interval or ordinal variable, were associated with long-term neurological outcome in separate models. According to the three models, a PaO 2 level of 200-300 mm Hg has the lowest risk of poor long-term neurological outcome. The results of the analysis of the predicted probability of poor long-term outcome according to the PaO 2 level exhibited a U-shaped curve. Further large-scale studies are needed to confirm the association between 200-300 mm Hg of PaO 2 and long-term neurological outcome and evaluate the impact of PaO 2 levels above 300 mm Hg on acute CO poisoning outcome. K E Y W O R D Scarbon monoxide, Glasgow Outcome Scale, hyperoxia, oxygen, poisoning

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“…More recently, research has also focused on the role of hyperoxemia. In fact, PaO 2 levels > 100 mmHg seem to have deleterious effects on outcome in critically ill patients overall [6,7] and the threshold changes only slightly in specific subpopulations such as post-cardiac arrest (PaO 2 levels > 120 mmHg) [8,9] or aneurysmal subarachnoid hemorrhage (aSAH) (PaO 2 > 200 mmHg) patients [10]. Moreover, the concept of PaO 2 variability, defined as the daily difference between the highest and the lowest PaO 2 values, has recently been identified as a potential surrogate marker for relative ischemiareperfusion injury [11,12].…”

mentioning

confidence: 99%

Oxygenation derangements after subarachnoid hemorrhage: incidence and impact on the outcome. Data from a large multicenter, retrospective study.

Citerio¹,

Aurelien²,

Chiara³

et al. 2019

Preprint

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BackgroundHypoxemia and hyperoxemia are frequent after acute subarachnoid hemorrhage (aSAH) and are associated with an increase in morbidity and mortality. Among the pulmonary complications causing oxygen derangements, acute respiratory distress syndrome (ARDS) seems to be crucial, with a reported incidence ranging from 11 to 50%. MethodsWe designed a multicentric, retrospective cohort study in tree intensive care in Europe. We collected data between January 2009 and December 2017. We included adult patients (≥18 years) with a diagnosis of aSAH. Hypoxemia was defined as PaO2 <60mmHg, mild hyperoxemia as PaO2>120mmHg, and severe hyperoxemia as PaO2>200mmHg. The primary aim of this study was to assess the incidence of episodes of hypoxemia, hyperoxemia, and the oxygen variability values (calculated as the daily difference between the highest and the lowest arterial partial pressure of oxygen (PaO2)) during the first week after the intensive care unit (ICU) admission. Secondary aims included the evaluation of the incidence of ARDS according to the Berlin criteria, and the assessment of the effect of oxygen derangements on patients’ outcomes.Results855 patients fulfilled the inclusion criteria. 6.4% of the patients presented at least one episode of hypoxemia (PaO2 <60mmHg), 56.6% of mild hyperoxemia (PaO2 >120mmHg), and 16.8% of severe hyperoxemia (PaO2 >200mmHg). The cumulative incidence of ARDS resulted in 2.2% on the first day since ICU admission, 3.2% by three days, and 3.6% by seven days. A lower Glasgow Coma Scale score (GCS) at admission, longer duration of mechanical ventilation, higher PaO2 variability, hypoxemia, and ARDS occurrence were independently associated with poor outcome.ConclusionsHypoxemia and hyperoxemia episodes are frequent in the first 7-days of ICU stay after aSAH, whereas ARDS has a low incidence. The severity of aSAH but also ARDS occurrence, oxygenation parameters, and duration of MV are associated with patients’ outcomes

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Early Hyperoxia in The Intensive Care Unit is Significantly Associated With Unfavorable Neurological Outcomes in Patients With Mild-to-Moderate Aneurysmal Subarachnoid Hemorrhage

Abstract: Early hyperoxia was not associated with unfavorable neurological outcomes in overall SAH patients, but it was associated with unfavorable neurological outcomes in those with H&K grades I-III.

Cited by 24 publications

References 33 publications

Association between Early Hyperoxia and Neurologic Outcome in Patient with High Grade Aneurysmal Subarachnoid Hemorrhage

Association between Early Hyperoxia and Neurologic Outcome in Patient with High Grade Aneurysmal Subarachnoid Hemorrhage

Is an increased PaO₂ in a normobaric state safe in acute CO poisoning?

Oxygenation derangements after subarachnoid hemorrhage: incidence and impact on the outcome. Data from a large multicenter, retrospective study.

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Early Hyperoxia in The Intensive Care Unit is Significantly Associated With Unfavorable Neurological Outcomes in Patients With Mild-to-Moderate Aneurysmal Subarachnoid Hemorrhage

Abstract: Early hyperoxia was not associated with unfavorable neurological outcomes in overall SAH patients, but it was associated with unfavorable neurological outcomes in those with H&K grades I-III.

Cited by 24 publications

References 33 publications

Association between Early Hyperoxia and Neurologic Outcome in Patient with High Grade Aneurysmal Subarachnoid Hemorrhage

Association between Early Hyperoxia and Neurologic Outcome in Patient with High Grade Aneurysmal Subarachnoid Hemorrhage

Is an increased PaO2 in a normobaric state safe in acute CO poisoning?

Oxygenation derangements after subarachnoid hemorrhage: incidence and impact on the outcome. Data from a large multicenter, retrospective study.

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Is an increased PaO₂ in a normobaric state safe in acute CO poisoning?