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Association between high arterial oxygen tension and long-term survival after intracerebral hemorrhage

Introduction

Liberal use of oxygen after brain insults remains controversial [1, 2]. We studied whether high arterial oxygen tension (PaO2) is associated with decreased long-term survival in patients with spontaneous intracerebral hemorrhage (ICH) treated in the ICU.

Methods

Data on primary admissions for adult patients (>18 years) treated for ICH in Finnish ICUs between 2003 and 2012 were collected from a nationwide ICU database. Patients were divided into three groups according to the PaO2 value associated with the lowest measured PaO2/ FIO2 ratio during the first 24 hours after ICU admission. High arterial oxygen tension was defined as PaO2 >19.9 kPa; intermediate as PaO2 13 to 19.9 kPa; and low as PaO2 <13 kPa. The primary outcome was 6-month mortality.

Results

Of the 3,033 patients, 63% (n = 1,923) had low PaO2, 29% (n = 892) intermediate PaO2, and 7% (n = 218) high PaO2. Forty-nine percent of the patients died during the 6-month follow-up. Of these, 75% died before discharge from hospital. Univariate analysis showed that 6-month mortality was higher in the high PaO2 group (61%) compared with the intermediate and low PaO2 groups (52% and 46% respectively, P < 0.001). Multivariate analysis, however, showed no statistically significant correlation between high PaO2 and mortality (with the low PaO2 group as the reference category, odds ratio for death (OR) for high PaO2 = 1.10, 95% confidence interval (CI) = 0.76 to 1.58 and for intermediate PaO2 = 0.96, 95% CI = 0.78 to 1.17).

Conclusion

High PaO2 is not predictive of 6-month mortality in patients treated for spontaneous ICH in the ICU. Therefore, targeting higher PaO2 values appears to be a safe approach in order to avoid hypoxemia.

References

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Fallenius, M., Raj, R., Reinikainen, M. et al. Association between high arterial oxygen tension and long-term survival after intracerebral hemorrhage. Crit Care 19, P465 (2015). https://doi.org/10.1186/cc14545

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Keywords

  • Confidence Interval
  • Emergency Medicine
  • Intracerebral Hemorrhage
  • Reference Category
  • Safe Approach