Hyperoxia for sepsis and development of acute lung injury with increased mortality
Background Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection.Methods A post-hoc analysis of a nationwide multicentre prospe...
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BMJ Publishing Group
2023-07-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/10/1/e001968.full |
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| author | Kazuma Yamakawa Toshikazu Abe Daizoh Saitoh Hiroshi Ogura Seitaro Fujishima Ryo Yamamoto Junichi Sasaki Satoshi Gando |
| author_facet | Kazuma Yamakawa Toshikazu Abe Daizoh Saitoh Hiroshi Ogura Seitaro Fujishima Ryo Yamamoto Junichi Sasaki Satoshi Gando |
| author_sort | Kazuma Yamakawa |
| collection | DOAJ |
| description | Background Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection.Methods A post-hoc analysis of a nationwide multicentre prospective observational study on sepsis (SPICE Study) was conducted, including adult patients admitted to the intensive care unit with available arterial partial pressure of oxygen (PaO2) at the treatment initiation for severe infection. Hyperoxia was defined as a PaO2 level of ≥300 mm Hg and in-hospital mortality was compared between patients with and without hyperoxia.Results Of the 563 patients eligible for the study, 49 had hyperoxia at treatment initiation for severe infection. The in-hospital all-cause mortality rates of patients with and without hyperoxia were 14 (29.2%) and 90 (17.6%), respectively. Inverse probability weighting analyses with propensity scores revealed the association between hyperoxia and increased in-hospital mortality rate (28.8% vs 18.8%; adjusted OR 1.75 (1.03 to 2.97); p=0.038), adjusting for patient demographics, comorbidities, site of infection, severity of infection, haemodynamic and respiratory status, laboratory data and location of patient at infection development. Acute lung injury developed more frequently in patients with hyperoxia on the following days after infection treatment, whereas sepsis-related mortality was comparable regardless of hyperoxia exposure.Conclusion Hyperoxia with PaO2 ≥300 mm Hg at treatment initiation of severe infection was associated with an increased in-hospital mortality rate in patients requiring intensive care. The amount of oxygen to administer to patients with severe infection should be carefully determined.Trial registration number University Hospital Medical Information Network Clinical Trial Registry (UMIN000027452). |
| format | Article |
| id | doaj-art-d4d236403e424208a19af99fcaa1c26e |
| institution | DOAJ |
| issn | 2052-4439 |
| language | English |
| publishDate | 2023-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-d4d236403e424208a19af99fcaa1c26e2025-08-20T03:16:21ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392023-07-0110110.1136/bmjresp-2023-001968Hyperoxia for sepsis and development of acute lung injury with increased mortalityKazuma Yamakawa0Toshikazu Abe1Daizoh Saitoh2Hiroshi Ogura3Seitaro Fujishima4Ryo Yamamoto5Junichi Sasaki6Satoshi Gando7Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, JapanDepartment of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, JapanDepartment of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, JapanDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, JapanCenter for Preventive Medicine, Keio University Hospital, Tokyo, Japan1 Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, JapanDepartment of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, JapanDivision of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, JapanBackground Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection.Methods A post-hoc analysis of a nationwide multicentre prospective observational study on sepsis (SPICE Study) was conducted, including adult patients admitted to the intensive care unit with available arterial partial pressure of oxygen (PaO2) at the treatment initiation for severe infection. Hyperoxia was defined as a PaO2 level of ≥300 mm Hg and in-hospital mortality was compared between patients with and without hyperoxia.Results Of the 563 patients eligible for the study, 49 had hyperoxia at treatment initiation for severe infection. The in-hospital all-cause mortality rates of patients with and without hyperoxia were 14 (29.2%) and 90 (17.6%), respectively. Inverse probability weighting analyses with propensity scores revealed the association between hyperoxia and increased in-hospital mortality rate (28.8% vs 18.8%; adjusted OR 1.75 (1.03 to 2.97); p=0.038), adjusting for patient demographics, comorbidities, site of infection, severity of infection, haemodynamic and respiratory status, laboratory data and location of patient at infection development. Acute lung injury developed more frequently in patients with hyperoxia on the following days after infection treatment, whereas sepsis-related mortality was comparable regardless of hyperoxia exposure.Conclusion Hyperoxia with PaO2 ≥300 mm Hg at treatment initiation of severe infection was associated with an increased in-hospital mortality rate in patients requiring intensive care. The amount of oxygen to administer to patients with severe infection should be carefully determined.Trial registration number University Hospital Medical Information Network Clinical Trial Registry (UMIN000027452).https://bmjopenrespres.bmj.com/content/10/1/e001968.full |
| spellingShingle | Kazuma Yamakawa Toshikazu Abe Daizoh Saitoh Hiroshi Ogura Seitaro Fujishima Ryo Yamamoto Junichi Sasaki Satoshi Gando Hyperoxia for sepsis and development of acute lung injury with increased mortality BMJ Open Respiratory Research |
| title | Hyperoxia for sepsis and development of acute lung injury with increased mortality |
| title_full | Hyperoxia for sepsis and development of acute lung injury with increased mortality |
| title_fullStr | Hyperoxia for sepsis and development of acute lung injury with increased mortality |
| title_full_unstemmed | Hyperoxia for sepsis and development of acute lung injury with increased mortality |
| title_short | Hyperoxia for sepsis and development of acute lung injury with increased mortality |
| title_sort | hyperoxia for sepsis and development of acute lung injury with increased mortality |
| url | https://bmjopenrespres.bmj.com/content/10/1/e001968.full |
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