Incidence of hyperoxia and related in‐hospital mortality in critically ill patients: a retrospective data analysis

Kraft, Felix; Andel, H.; Gamper, Jutta; Markstaller, Klaus; Ullrich, Robert C.; Klein, Klaus Ulrich

doi:10.1111/aas.13047

Cited by 17 publications

(27 citation statements)

References 24 publications

(24 reference statements)

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“…Meanwhile, the lung would get injuries when exposed to hyperoxia within 24 h [52]. In Kraft’s study [53], they investigated the average oxygenation target during the whole ICU stay, which means the high PaO2 happened in the first 24 h might be offset by the low PaO2 value in the following days.…”

Section: Discussionmentioning

confidence: 99%

The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis

Wang²,

Liang

et al. 2019

BMC Pulm Med

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Background Studies investigating the role of hyperoxia in critically ill patients have reported conflicting results. We did this analysis to reveal the effect of hyperoxia in the patients admitted to the intensive care unit (ICU). Methods Electronic databases were searched for all the studies exploring the role of hyperoxia in adult patients admitted to ICU. The primary outcome was mortality. Random-effect model was used for quantitative synthesis of the adjusted odds ratio (aOR). Results We identified 24 trials in our final analysis. Statistical heterogeneity was found between hyperoxia and normoxia groups in patients with mechanical ventilation (I 2 = 92%, P < 0.01), cardiac arrest(I 2 = 63%, P = 0.01), traumatic brain injury (I 2 = 85%, P < 0.01) and post cardiac surgery (I 2 = 80%, P = 0.03). Compared with normoxia, hyperoxia was associated with higher mortality in overall patients (OR 1.22, 95% CI 1.12~1.33), as well as in the subgroups of cardiac arrest (OR 1.30, 95% CI 1.08~1.57) and extracorporeal life support (ELS) (OR 1.44, 95% CI 1.03~2.02). Conclusions Hyperoxia would lead to higher mortality in critically ill patients especially in the patients with cardiac arrest and ELS. Electronic supplementary material The online version of this article (10.1186/s12890-019-0810-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis

Wang²,

Liang

et al. 2019

BMC Pulm Med

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“…A recent meta‐analysis of trials in acutely ill patients overall underlined the potential detrimental effect of hyperoxaemia. Nevertheless, the tendency in ICUs is towards a liberal use of oxygen therapy and noteworthy, despite self‐reported restrictive preferences among ICU nurses and physicians . Importantly, hypoxaemia is associated with increased mortality as it may lead to a low tissue oxygen tension (PO 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…This emphasises the importance of continuous pulse oximetry during restrictive oxygenation practices, and vigilance of the nursing staff to avoid or minimise episodes of definitive hypoxaemia. When such precautions are taken however, an oxygenation target of 8 kPa may be superior to the conventional liberal approach of oxygen supplementation observed in current clinical practice . Restrictive oxygenation is recommended in patients with chronic obstructive pulmonary disease (COPD) outside the ICUs targeting an arterial oxygen saturation measured by pulse oximetry (SpO 2 ) of 88% to 92%; in ICU patients with acute respiratory distress syndrome (ARDS) ‘low normoxaemia’’ defined as an arterial partial pressure of oxygen (PaO 2 ) from 7.3 to 10.7 kPa is often targeted, however, not recommended in current clinical guidelines due to lack of evidence …”

Section: Introductionmentioning

confidence: 99%

Handling Oxygenation Targets in the Intensive Care Unit (HOT‐ICU)—Protocol for a randomised clinical trial comparing a lower vs a higher oxygenation target in adults with acute hypoxaemic respiratory failure

Schjørring

Perner

Wetterslev

et al. 2019

Acta Anaesthesiol Scand

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Background: Acutely ill adults with hypoxaemic respiratory failure are at risk of lifethreatening hypoxia, and thus oxygen is often administered liberally. Excessive oxygen use may, however, increase the number of serious adverse events, including death. Establishing the optimal oxygenation level is important as existing evidence is of low quality. We hypothesise that targeting an arterial partial pressure of oxygen (PaO 2 ) of 8 kPa is superior to targeting a PaO 2 of 12 kPa in adult intensive care unit (ICU) patients with acute hypoxaemic respiratory failure. Methods:The Handling Oxygenation Targets in the ICU (HOT-ICU) trial is an outcome assessment blinded, multicentre, randomised, parallel-group trial targeting PaO 2 in acutely ill adults with hypoxaemic respiratory failure within 12 hours after ICU admission. Patients are randomised 1:1 to one of the two PaO 2 targets throughout ICU stay until a maximum of 90 days. The primary outcome is 90-day mortality.Secondary outcomes are serious adverse events in the ICU, days alive without organ support and days alive out of hospital in the 90-day period; mortality, health-related | 957 SCHJØRRING et al.

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“…However, another retrospective single-centre study in general ICU patients mechanically ventilated for at 7 days did not show any association between in-hospital mortality and time-weighted PaO 2 > 120 mmHg [ 26 ]. Furthermore, other authors had even reported nadir mortality in a general ICU population at a mean PaO 2 over the total ICU length of stay ≈ 120–150 mmHg, while exposure to PaO 2 > 200 mmHg was indeed associated with increased mortality [ 27 ].…”

Section: General Icu and Emergency Department (Ed) Populationsmentioning

confidence: 99%

Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients

Demiselle

Calzia

Hartmann

et al. 2021

Ann. Intensive Care

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There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 concentrations (FIO2), and the consecutive hyperoxaemia, i.e. supraphysiological arterial O2 tensions (PaO2), have a place during the acute management of circulatory shock. This concept is based on experimental evidence that hyperoxaemia may contribute to the compensation of the imbalance between O2 supply and requirements. However, despite still being common practice, its use is limited due to possible oxygen toxicity resulting from the increased formation of reactive oxygen species (ROS) limits, especially under conditions of ischaemia/reperfusion. Several studies have reported that there is a U-shaped relation between PaO2 and mortality/morbidity in ICU patients. Interestingly, these mostly retrospective studies found that the lowest mortality coincided with PaO2 ~ 150 mmHg during the first 24 h of ICU stay, i.e. supraphysiological PaO2 levels. Most of the recent large-scale retrospective analyses studied general ICU populations, but there are major differences according to the underlying pathology studied as well as whether medical or surgical patients are concerned. Therefore, as far as possible from the data reported, we focus on the need of mechanical ventilation as well as the distinction between the absence or presence of circulatory shock. There seems to be no ideal target PaO2 except for avoiding prolonged exposure (> 24 h) to either hypoxaemia (PaO2 < 55–60 mmHg) or supraphysiological (PaO2 > 100 mmHg). Moreover, the need for mechanical ventilation, absence or presence of circulatory shock and/or the aetiology of tissue dysoxia, i.e. whether it is mainly due to impaired macro- and/or microcirculatory O2 transport and/or disturbed cellular O2 utilization, may determine whether any degree of hyperoxaemia causes deleterious side effects.

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Incidence of hyperoxia and related in‐hospital mortality in critically ill patients: a retrospective data analysis

Abstract: Substantial hyperoxia burden was observed in ICU patients. Young patients with less comorbidities showed hyperoxic episodes more often, especially with lower FiO . Hyperoxia during 7 days of mechanical ventilation did not correlate to increased in-hospital mortality.

Cited by 17 publications

References 24 publications

The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis

The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis

Handling Oxygenation Targets in the Intensive Care Unit (HOT‐ICU)—Protocol for a randomised clinical trial comparing a lower vs a higher oxygenation target in adults with acute hypoxaemic respiratory failure

Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients

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