TY - JOUR
T1 - Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay
T2 - inverse probability of treatment weighting analysis
AU - on behalf of the Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group
AU - Yamamoto, Ryo
AU - Fujishima, Seitaro
AU - Sasaki, Junichi
AU - Gando, Satoshi
AU - Saitoh, Daizoh
AU - Shiraishi, Atsushi
AU - Kushimoto, Shigeki
AU - Ogura, Hiroshi
AU - Abe, Toshikazu
AU - Mayumi, Toshihiko
AU - Kotani, Joji
AU - Nakada, Taka aki
AU - Shiino, Yasukazu
AU - Tarui, Takehiko
AU - Okamoto, Kohji
AU - Sakamoto, Yuichiro
AU - Shiraishi, Shin Ichiro
AU - Takuma, Kiyotsugu
AU - Tsuruta, Ryosuke
AU - Masuno, Tomohiko
AU - Takeyama, Naoshi
AU - Yamashita, Norio
AU - Ikeda, Hiroto
AU - Ueyama, Masashi
AU - Hifumi, Toru
AU - Yamakawa, Kazuma
AU - Hagiwara, Akiyoshi
AU - Otomo, Yasuhiro
N1 - Funding Information:
This study was supported by the Japanese Association for Acute Medicine (JAAM, 2014-01). The JAAM FORECST Study Group thanks Shuta Fukuda for his special assistance in completing the study.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Information on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes. Methods: A post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models. Results: Among 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay. Conclusions: Hyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED. Trial registration: UMIN-CTR, UMIN000019588. Registered on November 15, 2015.
AB - Background: Information on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes. Methods: A post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models. Results: Among 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay. Conclusions: Hyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED. Trial registration: UMIN-CTR, UMIN000019588. Registered on November 15, 2015.
KW - Critically ill
KW - Hyperoxemia
KW - Hyperoxia
KW - ICU length of stay
KW - Mortality
KW - Trauma
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U2 - 10.1186/s13017-021-00363-2
DO - 10.1186/s13017-021-00363-2
M3 - Article
C2 - 33926507
AN - SCOPUS:85105164793
SN - 1749-7922
VL - 16
JO - World Journal of Emergency Surgery
JF - World Journal of Emergency Surgery
IS - 1
M1 - 19
ER -