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

doi:10.1177/00368504231160416

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

Sci Prog. 2023 Jan-Mar;106(1):368504231160416. doi: 10.1177/00368504231160416.

Authors

David J Douin¹, Layne Dylla², Erin L Anderson², John D Rice³, Conner L Jackson³, Vikhyat S Bebarta^{2

3

4}, Robert T Neumann⁵, Steven G Schauer^{6

7}, Adit A Ginde^{2

4}

Affiliations

¹ Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
² Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
³ Department of Biostatistics and Informatics, 144805Colorado School of Public Health, Aurora, CO, USA.
⁴ Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁵ Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
⁶ US Air Force 59th Medical Wing, Office of the Chief Scientist, JBSA, Lackland, TX, USA.
⁷ 110230US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA.

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.

Keywords: Critical care; combat; hyperoxia; intensive care unit; supplemental oxygen; trauma; traumatic brain injury.

Publication types

Multicenter Study

MeSH terms

Adult
Brain Injuries*
Brain Injuries, Traumatic*
Critical Illness
Humans
Hyperoxia*
Prospective Studies
Retrospective Studies