Crtical Care and Shock Journal

Hyperoxia is associated with higher case-fatality in ventilated patients with intra-cerebral hemorrhage

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Overview

Abstract
Objectives: To test the hypothesis that hyperoxia was associated with higher in-hospital case-fatality in ventilated patients with ICH admitted to the Intensive Care Unit (ICU).
Methods: Admissions of ventilated ICH patients within 24 hours of admission to the ICU at 77 United States hospitals between 2003-2008. Patients were divided into three exposure groups: hyperoxia (PaO2≥300 mmHg), hypoxia (PaO2<60 mmHg or PaO2/FiO2 ratio ≤300), and normoxia, not defined as hyperoxia or hypoxia. The primary outcome was in-hospital case-fatality.
Results: 1,388 ventilated ICH patients. Mean age 63 years (SD 15), 47% (653/1388) female, and median GCS 5 (IQR 3-8). The overall case-fatality was 59% (812/1388). Upon admission to the ICU, 36% (492/1388) were normoxic, 47% (641/1388) were hypoxic, and 17% (238/1388) were hyperoxic on ABGt1. ABGt2 was accomplished in 780 patients, of whom 46% (352/780) were normoxic, 45% (352/780) were hypoxic, and 9% (67/780) were hyperoxic. Of the initially admitted hyperoxic patients, 15% (21/138) remained hyperoxic and had a case-fatality of 82% (18/21) as compared to 49% (67/138) who became normoxic and had a case-fatality of 46% (32/67) (crude OR 6.6, 95%CI:1.8-25, χ2=9.4, p=0.002). In a multivariable analysis controlling for other predictors of poor outcome and hospital specific characteristics, and a propensity-score, failure to correct hyperoxia was associated with higher case-fatality (adjusted OR 2.5, 95%CI:1.1-6.1, p=0.04).
Conclusion: In ventilated ICH patients, failure to normalize hyperoxia was associated with higher case-fatality. These data underscore the need for studies of controlled re-oxygenation in ventilated ICH patients.

Fred Rincon, Matthew Vibbert, Jacqueline Urtecho, M. Kamran Athar, William McBride, Jack Jallo, Rodney Bell

Fred Rincon, Matthew Vibbert, Jacqueline Urtecho, M. Kamran Athar, William McBride, Jack Jallo, Rodney Bell

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