Functional Outcomes in Patients Admitted to the Intensive Care Unit with Traumatic Brain Injury and Exposed to Hyperoxia: A Retrospective Multicentre Cohort Study.

Content Provider	Europe PMC
Author	Weeden, M. Bailey, M. Gabbe, B. Pilcher, D. Bellomo, R. Udy, A.
Abstract	BackgroundSupplemental oxygen administration to critically ill patients is ubiquitous in the intensive care unit (ICU). Uncertainty persists as to whether hyperoxia is benign in patients with traumatic brain injury (TBI), particularly in regard to their long-term functional neurological outcomes.MethodsWe conducted a retrospective multicenter cohort study of invasively ventilated patients with TBI admitted to the ICU. A database linkage between the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD) and the Victorian State Trauma Registry (VSTR) was utilized. The primary exposure variable was minimum acute physiology and chronic health evaluation (APACHE) III PaO2 in the first 24 h of ICU. We defined hypoxia as PaO2 < 60 mmHg, normoxia as 60–299 mmHg, and hyperoxia as ≥ 300 mmHg. The primary outcome was a Glasgow Outcome Scale-Extended (GOSE) < 5 at 6 months while secondary outcomes included 12 and 24 months GOSE and mortality at each of these timepoints. Additional sensitivity analyses were undertaken in the following subgroups: isolated head injury, patients with operative intervention, head injury severity, and PaO2 either subcategorized by increments of 60 mmHg or treated as a continuous variable.ResultsA total of 3699 patients met the inclusion criteria. The mean age was 42.8 years, 77.7% were male and the mean acute physiology and chronic health evaluation (APACHE) III score was 60.1 (26.3). 2842 patients experienced normoxia, and 783 hyperoxia. The primary outcome occurred in 1470 (47.1%) of patients overall with 1123 (47.1%) from the normoxia group and 312 (45.9%) from the hyperoxia group—odds ratio 0.99 (0.78–1.25). No significant differences in outcomes between groups at 6, 12, and 24 months were observed. Sensitivity analyses did not identify subgroups that were adversely affected by exposure to hyperoxia.ConclusionsNo associations were observed between hyperoxia in ICU during the first 24 h and adverse neurological outcome at 6 months in ventilated TBI patients.Electronic supplementary materialThe online version of this article (10.1007/s12028-020-01033-y) contains supplementary material, which is available to authorized users.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7338132&blobtype=pdf
ISSN	15416933
Journal	Neurocritical Care [Neurocrit Care]
Volume Number	34
DOI	10.1007/s12028-020-01033-y
PubMed Central reference number	PMC7338132
Issue Number	2
PubMed reference number	32632905
e-ISSN	15560961
Language	English
Publisher	Springer US
Publisher Date	2021-04-01
Publisher Place	New York
Access Restriction	Open
Rights License	This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020
Subject Keyword	Hyperoxia Critical care Traumatic brain injury Functional neurological outcome Glasgow Outcome Score-Extended Oxygen toxicity
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Critical Care and Intensive Care Medicine