Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis.
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Yamamoto Ryo, Fujishima Seitaro, Sasaki Junichi, Gando Satoshi, Saitoh Daizoh, Shiraishi Atsushi, Kushimoto Shigeki, Ogura Hiroshi, Abe Toshikazu, Mayumi Toshihiko, Kotani Joji, Nakada Taka-Aki, Shiino Yasukazu, Tarui Takehiko, Okamoto Kohji, Sakamoto Yuichiro, Shiraishi Shin-Ichiro, Takuma Kiyotsugu, Tsuruta Ryosuke, Masuno Tomohiko, Takeyama Naoshi, Yamashita Norio, Ikeda Hiroto, Ueyama Masashi, Hifumi Toru, Yamakawa Kazuma, Hagiwara Akiyoshi, Otomo Yasuhiro, Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group
Аннотация
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.