Effect of Different Early Oxygenation Levels on Clinical Outcomes of Patients Presenting in the Emergency Department With Severe Traumatic Brain Injury

被引:2
|
作者
Vrettou, Charikleia S. [1 ]
Giannakoulis, Vassilis G. [1 ]
Gallos, Parisis [2 ]
Kotanidou, Anastasia [1 ]
Siempos, Ilias I. [1 ,3 ]
机构
[1] Natl & Kapodistrian Univ Athens, Evangelismos Hosp, Dept Crit Care Med & Pulm Serv, Med Sch, Athens, Greece
[2] Univ Piraeus, Dept Digital Syst, Computat Biomed Lab, Piraeus, Greece
[3] Weill Cornell Med, Dept Med, Div Pulm & Crit Care Med, New York, NY 10021 USA
关键词
CEREBRAL-BLOOD-FLOW; SEVERE HEAD-INJURY; NORMOBARIC HYPEROXIA; HYPOXIA; LUNG; METABOLISM; GUIDELINES;
D O I
10.1016/j.annemergmed.2022.09.026
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objective: Despite the almost universal administration of supplemental oxygen in patients presenting in the emergency department (ED) with severe traumatic brain injury, optimal early oxygenation levels are unknown. Therefore, we aimed to examine the effect of different early oxygenation levels on the clinical outcomes of patients presenting in the emergency department with severe traumatic brain injury. Methods: We performed a secondary analysis of the Resuscitation Outcomes Consortium Traumatic Brain Injury Hypertonic Saline randomized controlled trial by including patients with Glasgow Coma Scale <8. Early oxygenation levels were assessed by the worst value of arterial partial pressure of oxygen (PaO2) during the first 4 hours of presentation in the emergency department. The primary outcome was 6-month neurologic status, as assessed by the Extended Glasgow Outcome Scale. A binary logistic regression was utilized, and an odds ratio (OR) with 95% (95% confidence intervals) was calculated. Results: A total of 910 patients were included. In unadjusted (crude) analysis, a PaO2 of 101 to 250 mmHg (OR, 0.59 [0.38 to 0.91]), or 251 to 400 mmHg (OR, 0.53 [0.34 to 0.83]) or >= 401 mmHg (OR, 0.31 [0.20 to 0.49]) was less likely to be associated with poor neurologic status when compared with a PaO2 of <= 100 mmHg. This was also the case for adjusted analyses (including age, pupillary reactivity, and Revised Trauma Score). Conclusion: High oxygenation levels as early as the first 4 hours of presentation in the emergency department may not be adversely associated with the long-term neurologic status of patients with severe traumatic brain injury. Therefore, during the early phase of trauma, clinicians may focus on stabilizing patients while giving low priority to the titration of oxygenation levels.
引用
收藏
页码:273 / 281
页数:9
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