Hyperoxemia and Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Reynolds, Rebecca A.; Amin, Shaunak N; Jonathan, Sumeeth; Tang, Alan R.; Lan, Matthews; Wang, Chunxue; Bastarache, Julie A.; Ware, Lorraine B.; Thompson, Reid C.

doi:10.1007/s12028-020-01136-6

Cited by 22 publications

(23 citation statements)

References 40 publications

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“…In two retrospective studies, including a mixed population of brain-injured patients, hyperoxaemia, defined as PaO 2 > 300 mmHg [ 87 ] or > 120 mmHg [ 88 ], was associated with increased in-hospital mortality and poor neurological outcome, even after adjusting for confounders. Patients with subarachnoid haemorrhage exposed to higher PaO 2 levels were also more likely to develop cerebral vasospasm [ 89 , 90 ]; however, a retrospective analysis of patients needing mechanically ventilation did not find any relation between time-weighted PaO 2 and outcome [ 91 ]. Studies in acute ischaemic stroke in general [ 92 ], and in a sub-group needing mechanical ventilation [ 93 ], found no association between outcome and PaO 2 within the first 24 h. Even early hyperoxaemia (PaO 2 > 300 mmHg) did not affect mortality in mechanically ventilated TBI patients, notwithstanding severity on admission [ 94 , 95 ].…”

Section: Acute Brain Injurymentioning

confidence: 99%

Dangers of hyperoxia

et al. 2021

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Oxygen (O2) toxicity remains a concern, particularly to the lung. This is mainly related to excessive production of reactive oxygen species (ROS). Supplemental O2, i.e. inspiratory O2 concentrations (FIO2) > 0.21 may cause hyperoxaemia (i.e. arterial (a) PO2 > 100 mmHg) and, subsequently, hyperoxia (increased tissue O2 concentration), thereby enhancing ROS formation. Here, we review the pathophysiology of O2 toxicity and the potential harms of supplemental O2 in various ICU conditions. The current evidence base suggests that PaO2 > 300 mmHg (40 kPa) should be avoided, but it remains uncertain whether there is an “optimal level” which may vary for given clinical conditions. Since even moderately supra-physiological PaO2 may be associated with deleterious side effects, it seems advisable at present to titrate O2 to maintain PaO2 within the normal range, avoiding both hypoxaemia and excess hyperoxaemia.

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Section: Acute Brain Injurymentioning

confidence: 99%

Dangers of hyperoxia

et al. 2021

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“…Hyperoxemia is associated with neurological injury in patients with traumatic brain injury and aneurysmal subarachnoid hemorrhage [17,18]. Hyperoxemia leads to the production of reactive oxygen species, which destroys cells and further promotes the in ammatory response [18].…”

Section: Discussionmentioning

confidence: 99%

Optimal Oxygen Saturation Targets in Patients with Sepsis- Associated Encephalopathy: A Cohort Study from the MIMIC-IV Database

Zhao

Wang

et al. 2021

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Objectives: Patients with sepsis-associated encephalopathy (SAE) in the intensive care unit (ICU) are treated with supplemental oxygen. However, few studies have investigated the impact of oxygenation status on the patient with SAE, and the optimal oxygenation status target remains unclear. We aimed to investigate the relationship between optimal oxygenation status and patients with SAE.Methods: This study is a retrospective cohort study. Patients were diagnosed with sepsis3.0 at the first ICU admission between 2008 and 2019 from Medical Information Mart for Intensive Care IV (MIMIC IV). We use generalized additive models to estimate the optimal oxygen saturation targets in patients with SAE. Multivariate logistic analysis to further confirm it. Measurements and Main Results: A total of 6714 patients with SAE were included. The incidence of patients with SAE was 66.8%, and hospital mortality was 7.9%. SpO2≤92% was the independent risk factor of incidence in patients with SAE. The optimal range of SpO2 was 93%–97%, which can reduce the incidence of patients with SAE. The optimal range of SpO2 was 92%–96%, reducing the hospital mortality of patients with SAE.Conclusions: The optimal range of SpO2 was 93%–96% reduce the hospital mortality and incidence of patients with SAE. SAE patients need conservative oxygen therapy

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“…An observational cohort study showed that exposure to hyperoxia was associated with a three-time-higher risk of delayed cerebral ischemia and twice the risk of poor 3-monthneurological outcome in patients with subarachnoid hemorrhage who required mechanical ventilation (67). Again Reynolds et al, in a single-center retrospective cohort study, demonstrated that, after SAH, early hyperoxia was independently associated with the occurrence of vasospasm but not with mortality (68). For this reason, in daily clinical practice, it is necessary to bear in mind that exposure to hyperoxia can have an impact on morbidity in patients after SAH.…”

Section: Pathological Consequencesmentioning

confidence: 99%

Revisited Hyperoxia Pathophysiology in the Perioperative Setting: A Narrative Review

et al. 2021

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The widespread use of high-dose oxygen, to avoid perioperative hypoxemia along with WHO-recommended intraoperative hyperoxia to reduce surgical site infections, is an established clinical practice. However, growing pathophysiological evidence has demonstrated that hyperoxia exerts deleterious effects on many organs, mainly mediated by reactive oxygen species. The purpose of this narrative review was to present the pathophysiology of perioperative hyperoxia on surgical wound healing, on systemic macro and microcirculation, on the lungs, heart, brain, kidneys, gut, coagulation, and infections. We reported here that a high systemic oxygen supply could induce oxidative stress with inflammation, vasoconstriction, impaired microcirculation, activation of hemostasis, acute and chronic lung injury, coronary blood flow disturbances, cerebral ischemia, surgical anastomosis impairment, gut dysbiosis, and altered antibiotics susceptibility. Clinical studies have provided rather conflicting results on the definitions and outcomes of hyperoxic patients, often not speculating on the biological basis of their results, while this review highlighted what happens when supranormal PaO2 values are reached in the surgical setting. Based on the assumptions analyzed in this study, we may suggest that the maintenance of PaO2 within physiological ranges, avoiding unnecessary oxygen administration, may be the basis for good clinical practice.

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Hyperoxemia and Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Cited by 22 publications

References 40 publications

Dangers of hyperoxia

Dangers of hyperoxia

Optimal Oxygen Saturation Targets in Patients with Sepsis- Associated Encephalopathy: A Cohort Study from the MIMIC-IV Database

Revisited Hyperoxia Pathophysiology in the Perioperative Setting: A Narrative Review

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