Ryo Yamamoto1, Seitaro Fujishima2, Junichi Sasaki1, Satoshi Gando3,4, Daizoh Saitoh5, Atsushi Shiraishi6, Shigeki Kushimoto7, Hiroshi Ogura8, Toshikazu Abe9,10, Toshihiko Mayumi11, Joji Kotani12, Taka-Aki Nakada13, Yasukazu Shiino14, Takehiko Tarui15, Kohji Okamoto16, Yuichiro Sakamoto17, Shin-Ichiro Shiraishi18, Kiyotsugu Takuma19, Ryosuke Tsuruta20, Tomohiko Masuno21, Naoshi Takeyama22, Norio Yamashita23, Hiroto Ikeda24, Masashi Ueyama25, Toru Hifumi26, Kazuma Yamakawa27, Akiyoshi Hagiwara28, Yasuhiro Otomo29. 1. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan. 2. Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. fujishim@keio.jp. 3. Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan. 4. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 5. Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan. 6. Emergency and Trauma Center, Kameda Medical Center, Kameda, Japan. 7. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. 8. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 9. Department of General Medicine, Juntendo University, Tokyo, Japan. 10. Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan. 11. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. 12. Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan. 13. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 14. Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan. 15. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan. 16. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan. 17. Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan. 18. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan. 19. Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan. 20. Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan. 21. Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan. 22. Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan. 23. Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan. 24. Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan. 25. Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan. 26. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan. 27. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan. 28. Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan. 29. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
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.
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 traumapatients 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 traumapatients not intubated at the ED. TRIAL REGISTRATION: UMIN-CTR, UMIN000019588 . Registered on November 15, 2015.
Authors: Hendrik J F Helmerhorst; Marie-José Roos-Blom; David J van Westerloo; Evert de Jonge Journal: Crit Care Med Date: 2015-07 Impact factor: 7.598
Authors: Brian W Roberts; J Hope Kilgannon; Benton R Hunter; Michael A Puskarich; Lisa Pierce; Michael Donnino; Marion Leary; Jeffrey A Kline; Alan E Jones; Nathan I Shapiro; Benjamin S Abella; Stephen Trzeciak Journal: Circulation Date: 2018-02-01 Impact factor: 29.690
Authors: Derek K Chu; Lisa H-Y Kim; Paul J Young; Nima Zamiri; Saleh A Almenawer; Roman Jaeschke; Wojciech Szczeklik; Holger J Schünemann; John D Neary; Waleed Alhazzani Journal: Lancet Date: 2018-04-26 Impact factor: 79.321
Authors: Paul Young; Diane Mackle; Rinaldo Bellomo; Michael Bailey; Richard Beasley; Adam Deane; Glenn Eastwood; Simon Finfer; Ross Freebairn; Victoria King; Natalie Linke; Edward Litton; Colin McArthur; Shay McGuinness; Rakshit Panwar Journal: Intensive Care Med Date: 2019-11-20 Impact factor: 17.440
Authors: Edward Palmer; Benjamin Post; Roman Klapaukh; Giampiero Marra; Niall S MacCallum; David Brealey; Ari Ercole; Andrew Jones; Simon Ashworth; Peter Watkinson; Richard Beale; Stephen J Brett; J Duncan Young; Claire Black; Aasiyah Rashan; Daniel Martin; Mervyn Singer; Steve Harris Journal: Am J Respir Crit Care Med Date: 2019-12-01 Impact factor: 21.405
Authors: Marta Martín-Fernández; María Heredia-Rodríguez; Paolo Pelosi; Jesús Villar; Eduardo Tamayo; Irene González-Jiménez; Mario Lorenzo-López; Estefanía Gómez-Pesquera; Rodrigo Poves-Álvarez; F Javier Álvarez; Pablo Jorge-Monjas; Juan Beltrán-DeHeredia; Eduardo Gutiérrez-Abejón; Francisco Herrera-Gómez; Gabriella Guzzo; Esther Gómez-Sánchez; Álvaro Tamayo-Velasco; Rocío Aller Journal: Crit Care Date: 2022-01-10 Impact factor: 9.097
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