Hyperoxia for sepsis and development of acute lung injury with increased mortality

Ryo Yamamoto; Seitaro Fujishima; Kazuma Yamakawa; Toshikazu Abe; Hiroshi Ogura; Daizoh Saitoh; Satoshi Gando; Junichi Sasaki

doi:10.1136/bmjresp-2023-001968

Hyperoxia for sepsis and development of acute lung injury with increased mortality

BMJ Open Respir Res. 2023 Dec 14;10(1):e001968. doi: 10.1136/bmjresp-2023-001968.

Authors

Ryo Yamamoto¹, Seitaro Fujishima², Kazuma Yamakawa³, Toshikazu Abe^{4

5}, Hiroshi Ogura⁶, Daizoh Saitoh⁷, Satoshi Gando^{8

9}, Junichi Sasaki¹⁰

Affiliations

¹ Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan ryo.yamamoto@gmail.com.
² Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan.
³ Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
⁴ Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
⁵ Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
⁶ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
⁷ Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.
⁸ Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.
⁹ Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
¹⁰ Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.

Abstract

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).

Keywords: ARDS; Critical Care; Oxidative Stress.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Lung Injury* / complications
Adult
Humans
Hyperoxia* / complications
Oxygen
Retrospective Studies
Sepsis*

Substances

Oxygen