Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study



Madotto, Fabiana, Rezoagli, Emanuele, Tai, Pham, Schmidt, Marcello, McNicholas, Bairbre, Protti, Alessandro, Panwar, Rakshit, Bellani, Giacomo, Fan, Eddy, van Haren, Frank
et al (show 2 more authors) (2020) Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study. CRITICAL CARE, 24 (1). 125-.

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Abstract

<h4>Background</h4>Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study.<h4>Methods</h4>In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO<sub>2</sub> > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO<sub>2</sub> ≥ 0.60 during hyperoxemia).<h4>Results</h4>Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO<sub>2</sub> < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO<sub>2</sub> use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO<sub>2</sub> use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO<sub>2</sub>. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO<sub>2</sub> use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO<sub>2</sub> use, compared to 39% in a propensity-matched sample of normoxemic (PaO<sub>2</sub> 55-100 mmHg) patients (P = 0.47).<h4>Conclusions</h4>Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort.<h4>Trial registration</h4>LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073.

Item Type: Article
Uncontrolled Keywords: Hyperoxia, Hypoxia, Hyperoxemia, Hypoxemia, Oxygen therapy, Acute respiratory distress syndrome, Mortality, Invasive mechanical ventilation
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 06 Jul 2021 09:57
Last Modified: 18 Jan 2023 21:36
DOI: 10.1186/s13054-020-2826-6
Open Access URL: https://doi.org/10.1186/s13054-020-2826-6
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3128991