Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/11382
Title: Arterial oxygen tension and mortality in mechanically ventilated patients.
Authors: Eastwood, Glenn M;Bellomo, Rinaldo;Bailey, Michael J;Taori, Gopal;Pilcher, David V;Young, Paul J;Beasley, Richard W
Affiliation: Austin Health, Department of Intensive Care, Heidelberg, Victoria, Australia. glenn.eastwood@austin.org.au
Issue Date: 30-Nov-2011
Citation: Intensive Care Medicine 2011; 38(1): 91-8
Abstract: Early hyperoxia may be an independent risk factor for mortality in mechanically ventilated intensive care unit (ICU) patients. We examined the relationship between early arterial oxygen tension (PaO(2)) and in-hospital mortality.We retrospectively assessed arterial blood gases (ABG) with 'worst' alveolar-arterial (A-a) gradient during the first 24 h of ICU admission for all ventilated adult patients from 150 participating ICUs between 2000 and 2009. We used multivariate analysis in all patients and defined subgroups to determine the relationship between PaO(2) and mortality. We also studied the relationship between worst PaO(2), admission PaO(2) and peak PaO(2) in a random cohort of patients.We studied 152,680 patients. Their mean PaO(2) was 20.3 kPa (SD 14.6) and mean inspired fraction of oxygen (FiO(2)) was 62% (SD 26). Worst A-a gradient ABG identified that 49.8% (76,110) had hyperoxia (PaO(2) > 16 kPa). Nineteen per cent of patients died in ICU and 26% in hospital. After adjusting for site, Simplified Acute Physiology Score II (SAPS II), age, FiO(2), surgical type, Glasgow Coma Scale (GCS) below 15 and year of ICU admission, there was an association between progressively lower PaO(2) and increasing in-hospital mortality, but not with increasing levels of hyperoxia. Similar findings were observed with a sensitivity analysis of PaO(2) derived from high FiO(2) (≥50%) versus low FiO(2) (<50%) and in defined subgroups. Worst PaO(2) showed a strong correlation with admission PaO(2) (r = 0.98) and peak PaO(2) within 24 h of admission (r = 0.86).We found there was an association between hypoxia and increased in-hospital mortality, but not with hyperoxia in the first 24 h in ICU and mortality in ventilated patients. Our findings differ from previous studies and suggest that the impact of early hyperoxia on mortality remains uncertain.
Internal ID Number: 22127482
URI: http://ahro.austin.org.au/austinjspui/handle/1/11382
DOI: 10.1007/s00134-011-2419-6
URL: http://www.ncbi.nlm.nih.gov/pubmed/22127482
Type: Journal Article
Subjects: Adult
Aged
Aged, 80 and over
Anoxia.mortality
Australia.epidemiology
Blood Gas Analysis
Female
Hospital Mortality
Humans
Hyperoxia.mortality
Intensive Care Units
Male
Medical Audit
Middle Aged
Multivariate Analysis
New Zealand.epidemiology
Respiration, Artificial
Retrospective Studies
Appears in Collections:Journal articles

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