Supplemental Oxygen Requirements of Critically Injured Adults: An Observational Trial

Abstract

Objectives: The optimal amount of oxygen to deploy with pararescue personnel for combat casualty care is currently unknown. The purpose of this prospective observational trial was to determine the proportion of trauma patients requiring supplemental oxygen, whether high or low flow rates were needed, and to evaluate associations between injury characteristics and oxygen requirements.

Subjects and methods: Over 6 months, dedicated study assistants observed oxygen requirements and delivery during the first 3 hours of emergency care for trauma patients meeting our institution's highest level trauma team activation criteria.

Results: The mean age of 204 enrolled subjects was 37 years, 79% were male, median injury severity score was 9 (interquartile range 1-21), 58% suffered penetrating injuries. Most (69%) were admitted; 17% went directly to the operating room, and 38% went directly to the intensive care unit from the emergency department. 136/160 nonintubated patients were managed with no or low-flow supplemental oxygen. Penetrating injuries were less likely to require supplemental oxygen (relative risk 0.65, 95% confidence interval 0.50-0.84). Subjects with Glasgow Coma Scale scores <15, abdominal or chest injury, or hypotension were more likely to require supplemental oxygen.

Conclusion: There is significant opportunity to reduce the need for high-flow oxygen delivery to the battlespace.