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Randomized Controlled Trial
. 2025 Mar 16:230:309-319.
doi: 10.1016/j.freeradbiomed.2025.02.016. Epub 2025 Feb 15.

Oxidative stress in trauma patients receiving a restrictive or liberal oxygen strategy - A sub-study of the TRAUMOX2 trial

Tobias Arleth  1 , Josefine Baekgaard  2 , Felicia Dinesen  3 , Andreas Creutzburg  4 , Helene Dalsten  5 , Carl Johan Queitsch  6 , Sarah Sofie Wadland  7 , Oscar Rosenkrantz  8 , Volkert Siersma  9 , Claus Moser  10 , Peter Østrup Jensen  11 , Lars S Rasmussen  12 , Jacob Steinmetz  13
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Free article
Randomized Controlled Trial

Oxidative stress in trauma patients receiving a restrictive or liberal oxygen strategy - A sub-study of the TRAUMOX2 trial

Tobias Arleth et al. Free Radic Biol Med. .
Free article

Abstract

Introduction: A liberal supplemental oxygen approach is recommended for all severely injured trauma patients despite limited evidence. Liberal oxygen administration may cause oxidative stress. The aim of this study was to investigate the effect of an early restrictive oxygen strategy versus a liberal oxygen strategy in adult trauma patients on biomarkers of oxidative stress within 48 h of hospital admission.

Materials and methods: This was a single-centre, sub-study of an international, randomised controlled trial TRAUMOX2. In TRAUMOX2, patients were randomised shortly after trauma to a restrictive oxygen strategy (arterial oxygen saturation target of 94 %) or a liberal oxygen strategy (12-15 L of oxygen per minute or fraction of inspired oxygen of 0.6-1.0) for 8 h. Blood samplings were performed at four time points within 48 h after randomisation: upon arrival at the trauma centre, and at eight, 24, and 48 h post-randomisation. The primary outcome was the plasma level of malondialdehyde (MDA) 24 h post-randomisation. Secondary outcomes were numerous, and included the level of MDA at other time points, superoxide dismutase (SOD) at all time points, 30-day mortality, and major respiratory complications.

Results: The sub-study included 90 adult trauma patients. The median MDA levels at 24 h post-randomisation was 60.9 μM (95 % CI 49.5 to 73.4) in the restrictive oxygen group and 56.7 μM (95 % CI 46.9 to 68.2) in the liberal oxygen group, corresponding to a difference of -4.2 μM (95 % CI -19.8 to 10.5; P = 0.35). No significant differences were found in MDA or SOD at the other time points either. Neither did we find a significant difference in 30-day mortality or major respiratory complications.

Conclusions: In this sub-study of the TRAUMOX2 trial, no significant differences were found in biomarkers of oxidative stress between a restrictive oxygen strategy and liberal oxygen strategy in adult trauma patients.

Keywords: Injury; Oxidative stress; Oxygen; ROS; Supplemental oxygen; Trauma.

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Conflict of interest statement

Declarations of competing interest For all support for the present manuscript since the initial planning of the work with no time limit, these authors have the following to declare: Tobias Arleth has received funding for the present study and manuscript from the Danish Air Ambulance and Holger and Ruth Hesse's Memorial Foundation. The rest of the authors do not have any conflicts of interest to declare regarding the present manuscript. For conflicts of interests related to any entity the past 36 months not related to the present manuscript, these authors have the following to declare: Tobias Arleth received funding for three months of research PhD programme exchange from Knud Højgaard's Foundation, the William Demant Foundation, Christian and Ottilia Brorson's Travel Scholarships, the Medical Science Faculty Foundation of Copenhagen University, and the Consultant Dr. Med. Edgar Schnohr and wife Gilberte Schnohrs Foundation. Josefine Baekgaard received funding for the TRAUMOX2 trial from the Novo Nordisk Foundation and was awarded with the prize for “talented young researcher” by The Lundbeck Foundation, of which 47.000€ was allocated to research. Felicia Dinesen received grants from “Rigshospitalets Forskningspuljer” and the Danish Air Ambulance, and also received support for a PhD programme exchange from the Medical Science Faculty Foundation of Copenhagen University, William Demant Fonden, and Familien Hede Nielsens Fond. Jacob Steinmetz received funding of his professorship from the Norwegian Air Ambulance Foundation where payments are made to his organization, and he received funding for the TRAUMOX2 trial from the Novo Nordisk Foundation. The rest of the authors do not have any conflicts of interests to declare.

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