Maarit Lång1, Rahul Raj, Markus Benedikt Skrifvars, Timo Koivisto, Hanna Lehto, Riku Kivisaari, Mikael von Und Zu Fraunberg, Matti Reinikainen, Stepani Bendel. 1. *Department of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland; ‡Department of Neurosurgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland; §Division of Intensive Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; ¶Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland; ‖Department of Intensive Care Medicine, North Karelia Central Hospital, Joensuu, Finland.
Abstract
BACKGROUND: Targeting hyperoxemia is common practice in neurocritical care settings, but the safety of hyperoxemia has been questioned. OBJECTIVE: To investigate the independent effect of hyperoxemia on outcome in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: We included 432 patients with aneurysmal SAH on mechanical ventilation for at least 24 hours after intensive care unit (ICU) admission. Arterial blood gas levels were calculated as time-weighted averages (TWAs) of all blood gas measurements during the first 24 hours in the ICU. Patients were categorized into 3 TWA-PaO2 bands (low, <97.5 mm Hg; intermediate, 97.5-150 mm Hg; high, ≥150 mm Hg). Outcome measures were unfavorable outcome at 3 months (Glasgow Outcome Scale score 1-3) and mortality. Multivariate logistic regression analysis was used to assess the independent effect of oxygen on outcome. RESULTS: Overall, 28% of patients died, and a total of 53% had an unfavorable outcome at 3 months. Patients with an unfavorable outcome had significantly higher TWA-PaO2 levels compared with patients with a favorable outcome (137 mm Hg vs 118 mm Hg, P < .001). Multivariate analysis demonstrated no significant association between TWA-PaO2 bands and unfavorable outcome (with intermediate PaO2 as a reference, odds ratio [OR] for low PaO2 1.05, 95% confidence interval [CI]: 0.52-2.12, P = .89; OR for high PaO2: 1.09, 95% CI: 0.61-1.97, P = .77) or mortality (with intermediate PaO2 as reference, the OR for low PaO2 was 0.67 (95% CI: 0.30-1.46, P = .31), and the OR for high PaO2 was 0.73 (95% CI: 0.38-1.40, P = .34). CONCLUSION: Early moderate hyperoxemia may not increase or decrease the risk of a poor outcome in mechanically ventilated aneurysmal SAH patients.
BACKGROUND: Targeting hyperoxemia is common practice in neurocritical care settings, but the safety of hyperoxemia has been questioned. OBJECTIVE: To investigate the independent effect of hyperoxemia on outcome in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: We included 432 patients with aneurysmalSAH on mechanical ventilation for at least 24 hours after intensive care unit (ICU) admission. Arterial blood gas levels were calculated as time-weighted averages (TWAs) of all blood gas measurements during the first 24 hours in the ICU. Patients were categorized into 3 TWA-PaO2 bands (low, <97.5 mm Hg; intermediate, 97.5-150 mm Hg; high, ≥150 mm Hg). Outcome measures were unfavorable outcome at 3 months (Glasgow Outcome Scale score 1-3) and mortality. Multivariate logistic regression analysis was used to assess the independent effect of oxygen on outcome. RESULTS: Overall, 28% of patients died, and a total of 53% had an unfavorable outcome at 3 months. Patients with an unfavorable outcome had significantly higher TWA-PaO2 levels compared with patients with a favorable outcome (137 mm Hg vs 118 mm Hg, P < .001). Multivariate analysis demonstrated no significant association between TWA-PaO2 bands and unfavorable outcome (with intermediate PaO2 as a reference, odds ratio [OR] for low PaO2 1.05, 95% confidence interval [CI]: 0.52-2.12, P = .89; OR for high PaO2: 1.09, 95% CI: 0.61-1.97, P = .77) or mortality (with intermediate PaO2 as reference, the OR for low PaO2 was 0.67 (95% CI: 0.30-1.46, P = .31), and the OR for high PaO2 was 0.73 (95% CI: 0.38-1.40, P = .34). CONCLUSION: Early moderate hyperoxemia may not increase or decrease the risk of a poor outcome in mechanically ventilated aneurysmalSAHpatients.
Authors: Teodor Svedung Wettervik; Henrik Engquist; Anders Hånell; Timothy Howells; Elham Rostami; Elisabeth Ronne-Engström; Anders Lewén; Per Enblad Journal: Neurocrit Care Date: 2022-04-21 Impact factor: 3.532
Authors: Jaana Humaloja; Markus B Skrifvars; Rahul Raj; Erika Wilkman; Pirkka T Pekkarinen; Stepani Bendel; Matti Reinikainen; Erik Litonius Journal: Neurocrit Care Date: 2021-01-05 Impact factor: 3.210
Authors: Mervyn Singer; Paul J Young; John G Laffey; Pierre Asfar; Fabio Silvio Taccone; Markus B Skrifvars; Christian S Meyhoff; Peter Radermacher Journal: Crit Care Date: 2021-12-19 Impact factor: 9.097
Authors: James E Towner; Redi Rahmani; Christopher G Zammit; Imad R Khan; David A Paul; Tarun Bhalla; Debra E Roberts Journal: Crit Care Date: 2020-09-24 Impact factor: 9.097
Authors: Anniina H Autio; Juho Paavola; Joona Tervonen; Maarit Lång; Terhi J Huuskonen; Jukka Huttunen; Virve Kärkkäinen; Mikael von Und Zu Fraunberg; Antti E Lindgren; Timo Koivisto; Juha E Jääskeläinen; Olli-Pekka Kämäräinen Journal: Acta Neurochir (Wien) Date: 2021-02-25 Impact factor: 2.216