背景:创伤对全球健康构成重大挑战。尽管在严重受伤患者的管理方面取得了进展,(多)创伤仍然是全球发病率和死亡率的主要原因。在创伤复苏的背景下,通常按照指南的建议慷慨地进行补充氧气。然而,尚不确定创伤人群是否可能从更保守的补充氧气方法中获得优势。
方法:在这项来自两个瑞士创伤中心的回顾性队列研究中,严重伤害(>16岁)创伤严重程度评分(ISS)≥16的成人患者根据首次血气分析分为四组:低氧血症(PaO2<10.7kPa/80mmHg),正常血氧(PaO210.7-16.0kPa/80-120mmHg),作为参考,中度高氧血症(PaO2>16.0-40kPa/120-300mmHg)和重度高氧血症(PaO2>40kPa/300mmHg)。主要结果是28天死亡率。住院时间(LOS)和重症监护病房住院时间(LOS-ICU)作为次要结局进行分析。
结果:在1,189名创伤患者中,41.3%患有高氧血症(18.8%患有严重高氧血症),19.3%患有低氧血症。28天死亡率无差异(低氧血症:15.7%,正常血氧症:14.1%,高氧血症:13.8%,严重的高氧血症:16.0%,p=0.846)。严重高氧血症患者的LOS明显延长(中位数12.5[IQR7-18.5]天vs.10[7-17],p=0.040)和扩展的LOS-ICU(3.8[1.8-9]vs.2[1-5]天,p=0.149)与正常氧血症患者相比。在多变量分析中,氧氧组与主要结局28日死亡率或LOS-ICU无关.重度高氧血症患者有住院时间较长的趋势(调整系数2.23天[95%CI:-0.32;4.79],p=0.087)。
结论:与正常血氧症相比,高氧症与28天死亡率增加无关。然而,在创伤患者中经常观察到中度和重度高氧血症,与正常氧血症患者相比,严重的高氧血症的存在显示出住院时间延长的趋势。强有力的随机对照试验对于彻底评估高氧血症与创伤患者预后之间的潜在相关性至关重要。试用注册追溯注册。
BACKGROUND: Trauma poses a significant global health challenge. Despite advancements in the management of severely injured patients, (poly)trauma continues to be a primary contributor to morbidity and mortality worldwide. In the context of trauma resuscitation, supplemental oxygen is commonly administered generously as suggested by guidelines. Yet, it remains uncertain whether the trauma population might derive advantages from a more conservative approach to supplemental oxygen.
METHODS: In this retrospective cohort study from two Swiss trauma centers, severely injured adult (> 16 years) trauma patients with an Injury Severity Score (ISS) ≥ 16 were divided into four groups according to the first blood gas analysis taken: hypoxaemia (PaO2 < 10.7 kPa/80 mmHg), normoxaemia (PaO2 10.7-16.0 kPa/80-120 mmHg), which served as reference, moderate hyperoxaemia (PaO2 > 16.0-40 kPa/120-300 mmHg) and severe
hyperoxaemia (PaO2 > 40 kPa/300 mmHg). The primary outcome was 28-day mortality. Length of hospital stay (LOS) and length of intensive care unit stay (LOS-ICU) were analyzed as secondary outcomes.
RESULTS: Of 1,189 trauma patients, 41.3% had
hyperoxaemia (18.8% with severe
hyperoxaemia) and 19.3% had hypoxaemia. No difference was found for 28-day mortality (hypoxaemia: 15.7%, normoxaemia: 14.1%, hyperoxaemia: 13.8%, severe
hyperoxaemia: 16.0%, p = 0.846). Patients with severe
hyperoxaemia had a significant prolonged LOS (median 12.5 [IQR 7-18.5] days vs. 10 [7-17], p = 0.040) and extended LOS-ICU (3.8 [1.8-9] vs. 2 [1-5] days, p = 0.149) compared to normoxaemic patients. In multivariable analysis, oxygen group was not associated with the primary outcome 28-day mortality or LOS-ICU. Severe hyperoxaemia patients had a tendency towards longer hospital stay (adjusted coefficient 2.23 days [95% CI: - 0.32; 4.79], p = 0.087).
CONCLUSIONS: Hyperoxaemia was not associated with an increased 28-day mortality when compared to normoxaemia. However, both moderate and severe hyperoxaemia is frequently observed in trauma patients, and the presence of severe
hyperoxaemia showed a tendency with extended hospital stay compared to normoxaemia patients. Robust randomized controlled trials are imperative to thoroughly evaluate the potential correlation between hyperoxaemia and outcomes in trauma patients . Trial Registration Retrospectively registered.