Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis.
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.
['Yamamoto|Ryo|R|', 'Fujishima|Seitaro|S|0000-0001-8823-8440', 'Sasaki|Junichi|J|', 'Gando|Satoshi|S|', 'Saitoh|Daizoh|D|', 'Shiraishi|Atsushi|A|', 'Kushimoto|Shigeki|S|', 'Ogura|Hiroshi|H|', 'Abe|Toshikazu|T|', 'Mayumi|Toshihiko|T|', 'Kotani|Joji|J|', 'Nakada|Taka-Aki|TA|', 'Shiino|Yasukazu|Y|', 'Tarui|Takehiko|T|', 'Okamoto|Kohji|K|', 'Sakamoto|Yuichiro|Y|', 'Shiraishi|Shin-Ichiro|SI|', 'Takuma|Kiyotsugu|K|', 'Tsuruta|Ryosuke|R|', 'Masuno|Tomohiko|T|', 'Takeyama|Naoshi|N|', 'Yamashita|Norio|N|', 'Ikeda|Hiroto|H|', 'Ueyama|Masashi|M|', 'Hifumi|Toru|T|', 'Yamakawa|Kazuma|K|', 'Hagiwara|Akiyoshi|A|', 'Otomo|Yasuhiro|Y|', '|||']
D000328:Adult D000368:Aged D015415:Biomarkers D005260:Female D006801:Humans D018496:Hyperoxia D015601:Injury Severity Score D007362:Intensive Care Units D007564:Japan D007902:Length of Stay D008297:Male D008875:Middle Aged D011446:Prospective Studies D012151:Resuscitation D014947:Wounds and Injuries
Hyperoxemia Trauma ICU length of stay Critically ill Hyperoxia Mortality