Hyperoxia is associated with a greater risk for mortality in critically ill traumatic brain injury patients than in critically ill trauma patients without brain injury

David J. Douin, Layne Dylla, Erin L. Anderson, John D. Rice, Conner L. Jackson, Vikhyat S. Bebarta, Robert T. Neumann, Steven G. Schauer, Adit A. Ginde

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The role of hyperoxia in patients with traumatic brain injury (TBI) remains controversial. The objective of this study was to determine the association between hyperoxia and mortality in critically ill TBI patients compared to critically ill trauma patients without TBI. Design: Secondary analysis of a multicenter retrospective cohort study. Setting: Three regional trauma centers in Colorado, USA, between October 1, 2015, and June 30, 2018. Patients: We included 3464 critically injured adults who were admitted to an intensive care unit (ICU) within 24 h of arrival and qualified for inclusion into the state trauma registry. We analyzed all available SpO2 values during the first seven ICU days. The primary outcome was in-hospital mortality. Secondary outcomes included the proportion of time spent in hyperoxia (defined as SpO2 > 96%) and ventilator-free days. Interventions: None. Measurements and Main Results: In-hospital mortality occurred in 163 patients (10.7%) in the TBI group and 101 patients (5.2%) in the non-TBI group. After adjusting for ICU length of stay, TBI patients spent a significantly greater amount of time in hyperoxia versus non-TBI patients (p = 0.024). TBI status significantly modified the effect of hyperoxia on mortality. At each specific SpO2 level, the risk of mortality increases with increasing FiO2 for both patients with and without TBI. This trend was more pronounced at lower FiO2 and higher SpO2 values, where a greater number of patient observations were obtained. Among patients who required invasive mechanical ventilation, TBI patients required significantly more days of ventilation to day 28 than non-TBI patients. Conclusions: Critically ill trauma patients with a TBI spend a greater proportion of time in hyperoxia compared to those without a TBI. TBI status significantly modified the effect of hyperoxia on mortality. Prospective clinical trials are needed to better assess a possible causal relationship.

Original languageEnglish (US)
JournalScience Progress
Volume106
Issue number1
DOIs
StatePublished - Jan 1 2023
Externally publishedYes

Keywords

  • Critical care
  • combat
  • hyperoxia
  • intensive care unit
  • supplemental oxygen
  • trauma
  • traumatic brain injury

ASJC Scopus subject areas

  • General

Fingerprint

Dive into the research topics of 'Hyperoxia is associated with a greater risk for mortality in critically ill traumatic brain injury patients than in critically ill trauma patients without brain injury'. Together they form a unique fingerprint.

Cite this