Chiara Robba1,2, Rafael Badenes3,4, Florian Ebner5, Paolo Pelosi6,7, Denise Battaglini6,8, Lorenzo Ball6,7, Filippo Sanfilippo9, Iole Brunetti6, Janus Christian Jakobsen10,11, Gisela Lilja12, Hans Friberg13, Pedro David Wendel-Garcia14, Paul J Young15,16,17,18, Glenn Eastwood17,19, Michelle S Chew20, Johan Unden21,22, Matthew Thomas23, Michael Joannidis24, Alistair Nichol25, Andreas Lundin26, Jacob Hollenberg27, Naomi Hammond28, Manoj Saxena29, Annborn Martin30, Miroslav Solar31,32, Fabio Silvio Taccone33, Josef Dankiewicz34, Niklas Nielsen35, Anders Morten Grejs36,37. 1. Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. kiarobba@gmail.com. 2. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy. kiarobba@gmail.com. 3. Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain. 4. Department of Surgery, University of Valencia, Valencia, Spain. 5. Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Helsingborg Hospital, Lund University, 251 87, Helsingborg, Sweden. 6. Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. 7. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy. 8. Department of Medicine, University of Barcelona, Barcelona, Spain. 9. Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy. 10. Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. 11. Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. 12. Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41, Lund, Malmö, Sweden. 13. Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Lund, Sweden. 14. Institute of Intensive Care Medicine, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. 15. Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242, New Zealand. 16. Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand. 17. Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 18. Department of Critical Care, University of Melbourne, Parkville, VIC, Australia. 19. Department of Intensive Care, Austin Hospital, Melbourne, Australia. 20. Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 21. Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. 22. Department of Operation and Intensive Care, Hallands Hospital Halmstad, Lund University, Halland, Sweden. 23. University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 24. Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria. 25. Monash University, Melbourne, VIC, Australia. 26. Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45, Gothenburg, Sweden. 27. Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Solna, Sweden. 28. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia. 29. Intensive Care Unit, St George Hospital, Sydney, Australia. 30. Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden. 31. Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic. 32. Department of Internal Medicine - Cardioangiology, University Hospital Hradec Králové, Hradec Králové, Czech Republic. 33. Department of Intensive Care Medicine, Université Libre de Bruxelles, Hopital Erasme, Brussels, Belgium. 34. Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden. 35. Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden. 36. Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark. 37. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Abstract
BACKGROUND: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients' outcome. METHODS: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. RESULTS: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). CONCLUSIONS: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. TRIAL REGISTRATION: clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
BACKGROUND: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients' outcome. METHODS: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. RESULTS: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). CONCLUSIONS: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. TRIAL REGISTRATION: clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
Authors: Corinna Brueckl; Stephanie Kaestle; Alexander Kerem; Helmut Habazettl; Fritz Krombach; Hermann Kuppe; Wolfgang M Kuebler Journal: Am J Respir Cell Mol Biol Date: 2005-12-15 Impact factor: 6.914
Authors: Jerry P Nolan; Robert W Neumar; Christophe Adrie; Mayuki Aibiki; Robert A Berg; Bernd W Böttiger; Clifton Callaway; Robert S B Clark; Romergryko G Geocadin; Edward C Jauch; Karl B Kern; Ivan Laurent; W T Longstreth; Raina M Merchant; Peter Morley; Laurie J Morrison; Vinay Nadkarni; Mary Ann Peberdy; Emanuel P Rivers; Antonio Rodriguez-Nunez; Frank W Sellke; Christian Spaulding; Kjetil Sunde; Terry Vanden Hoek Journal: Resuscitation Date: 2008-10-28 Impact factor: 5.262
Authors: Rinaldo Bellomo; Michael Bailey; Glenn M Eastwood; Alistair Nichol; David Pilcher; Graeme K Hart; Michael C Reade; Moritoki Egi; D James Cooper Journal: Crit Care Date: 2011-03-08 Impact factor: 9.097
Authors: Florian Ebner; Susann Ullén; Anders Åneman; Tobias Cronberg; Niklas Mattsson; Hans Friberg; Christian Hassager; Jesper Kjærgaard; Michael Kuiper; Paolo Pelosi; Johan Undén; Matt P Wise; Jørn Wetterslev; Niklas Nielsen Journal: Crit Care Date: 2019-01-28 Impact factor: 9.097