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

Fabiana Madotto, Emanuele Rezoagli, Tài Pham, Marcello Schmidt, Bairbre McNicholas, Alessandro Protti, Rakshit Panwar, Giacomo Bellani, Eddy Fan, Frank Van Haren, Laurent Brochard, John G. Laffey, LUNG SAFE Investigators, ESICM Trials Group, Shailesh Bihari

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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 (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: 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. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

Original languageEnglish
Article number125
Number of pages17
JournalCritical Care
Volume24
Issue number1
DOIs
Publication statusPublished - 31 Mar 2020
Externally publishedYes

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Keywords

  • Acute respiratory distress syndrome
  • Hyperoxemia
  • Hyperoxia
  • Hypoxemia
  • Hypoxia
  • Invasive mechanical ventilation
  • Mortality
  • Oxygen therapy

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    Madotto, F., Rezoagli, E., Pham, T., Schmidt, M., McNicholas, B., Protti, A., Panwar, R., Bellani, G., Fan, E., Van Haren, F., Brochard, L., Laffey, J. G., LUNG SAFE Investigators, ESICM Trials Group, & Bihari, S. (2020). Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: Insights from the LUNG SAFE study. Critical Care, 24(1), [125]. https://doi.org/10.1186/s13054-020-2826-6