Sarah Alromaih1, Hind Alshabanat1, Nosaiba Alshanqiti1, Almaha Aldhuwaihy1, Sarah Abdullah Almohanna1, Muna Alqasem1, Fatmah Othman1,2 and Raymond M Khan1*
1Trauma & Intensive Care Unit, Collage of Medicine King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia 2Department of Research, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Saudi ArabiaFulltext PDF
Background: Traumatic Brain Injury (TBI) is a leading cause of morbidity and mortality globally. Currently, the association between hyperoxia and outcomes in patients with TBI remains debatable. We assessed the effect of hyperoxia on the neurological outcomes and survival of critically ill patients with moderate-severe TBI. Methods: This was a retrospective cohort study of all adults with moderate-severe TBI admitted to the ICU between January 1st, 2016 and December 31st, 2019 who required invasive mechanical ventilation. We noted ABGs performed with the first 3 h of intubation, then 6 h to 12 h and 24 h to 48 h. The patients were divided into two categories: Normoxia (PaO2 60 mmHg to 99 mmHg) and hyperoxia (PaO2>100 mmHg). Multivariable logistic regression was performed to assess predictors of hospital mortality and good neurologic outcome (Glasgow outcome score [GOS] ≥ 4). In a second analysis the patients were divided into survivors and non-survivors. Results: The study included 308 patients: 23.4% (n=72) in normoxia group and 76.6% (n=236) in hyperoxia group. Hyperoxia was not associated with increased hospital (43% vs. 18%, p=0.20) mortality. Further, the hospital discharge GCS (10 ± 5 vs. 11 ± 4, p=0.10) and GOS (3 ± 1 vs. 3 ± 1, p=0.35) were similar. In multivariable logistic regression analysis, hyperoxia was not associated with increased mortality (adjusted Odds Ratio [aOR] 0.99, 95% CI 0.99 to 1.00, p=0.11). PaO2 within different ranges was also not associated with mortality: 100 mmHg to 200 mmHg: aOR=0.60, 95% CI 0.29 to 1.52; 201 mmHg to 300 mmHg: aOR=0.66, 95% CI 0.29 to 1.52; 301 mmHg to 400 mmHg: aOR=0.80, 95% CI 0.31 to 2.09; and >400 mmHg: aOR=0.39, 95% CI 0.14 to 1.08; reference: PaO2 60 mmHg to 99 mmHg. The Kaplan-Meier survival curve for normoxia verses hyperoxia showed no significant difference for all-cause mortality. In the survivors verse non-survivors analysis, the PaO2 were (median, IQT) 199 mmHg (111 to 329) and 165 mmHg (84 to 252), respectively. Conclusion: Hyperoxia (PaO2>100 mmHg) was not associated with increased mortality or poor neurological outcomes (determined by GOS) in moderate-severe TBI patients.
Hyperoxia; Traumatic brain injury; Mortality; Neurological outcomes; Intensive care; Mechanical ventilator
Alromaih S, Alshabanat H, Alshanqiti N, Aldhuwaihy A, Almohanna SA, Alqasem M, et al. The Effect of Hyperoxia in Traumatic Brain Injury Patients in the Intensive Care Unit of a Tertiary Care Center. Ann Trauma Acute Care. 2021;5(1):1023..