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Observational Study
. 2018 Oct 25;8(10):e021758.
doi: 10.1136/bmjopen-2018-021758.

Harmful effects of early hyperoxaemia in patients admitted to general wards: an observational cohort study in South Korea

Jin Hee Jeong  1   2 , Dong Hoon Kim  1   2 , Tae Yun Kim  1 , Changwoo Kang  1   2 , Soo Hoon Lee  1 , Sang Bong Lee  1 , Seong Chun Kim  3 , Yong Joo Park  3
Affiliations
Observational Study

Harmful effects of early hyperoxaemia in patients admitted to general wards: an observational cohort study in South Korea

Jin Hee Jeong et al. BMJ Open. .

Abstract

Objectives: We evaluated the association between hyperoxaemia induced by a non-invasive oxygen supply for 3 days after emergency department (ED) arrival and the clinical outcomes at day 5 after ED arrival.

Design: Observational cohort study.

Setting and patients: Consecutive ED patients ≥16 years of age with available arterial blood gas analysis results who were admitted to our hospital were enrolled from January 2010 to December 2016.

Interventions: The highest (PaO2MAX), average (PaO2AVG) and median (PaO2MED) PaO2 (arterial oxygen pressure) values within 72 hours and the area under the curve divided by the time elapsed between ED admittance and the last PaO2 result (AUC72) were used to assess hyperoxaemia. The AUC72 values were calculated using the trapezoid rule.

Outcomes: The primary outcome was the 90-day in-hospital mortality rate. The secondary outcomes were intensive care unit (ICU) transfer and respiratory failure at day 5 after ED arrival, as well as new-onset cardiovascular, coagulation, hepatic and renal dysfunction at day 5 after ED arrival.

Results: Among the 10 141 patients, the mortality rate was 5.8%. The adjusted ORs of in-hospital mortality for PaO2MAX, PaO2AVG, PaO2MED and AUC72 were 0.79 (95% CI 0.61 to 1.02; p=0.0715), 0.92 (95% CI 0.69 to 1.24; p=0.5863), 0.82 (95% CI 0.61 to 1.11; p=0.2005) and 1.53 (95% CI 1.25 to 1.88; p<0.0001). All of the hyperoxaemia variables showed significant positive correlations with ICU transfer at day 5 after ED arrival (p<0.05). AUC72 was positively correlated with respiratory failure, as well as cardiovascular, hepatic and renal dysfunction (p<0.05). PaO2MAX was positively correlated with cardiovascular dysfunction. PaO2MAX and AUC72 were negatively correlated with coagulation dysfunction (p<0.05).

Conclusions: Hyperoxaemia during the first 3 days in patients outside the ICU is associated with in-hospital mortality and ICU transfer at day 5 after arrival at the ED.

Keywords: hyperoxaemia; hyperoxia; oxygen; oxygen inhalation therapy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The study patients. AUC, area under the curve; ED, emergency department; ICU, intensive care unit.
See this image and copyright information in PMC

Comment in

  • Oxygen: a powerful drug to handle with care.
    Coloretti I, Tosi M, Biagioni E, Girardis M. Coloretti I, et al. J Thorac Dis. 2019 Mar;11(Suppl 3):S226-S229. doi: 10.21037/jtd.2019.01.84. J Thorac Dis. 2019. PMID: 30997183 Free PMC article. No abstract available.

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