Intensive Care Medicine

, Volume 38, Issue 1, pp 91–98

Arterial oxygen tension and mortality in mechanically ventilated patients

  • Glenn Eastwood
  • Rinaldo Bellomo
  • Michael Bailey
  • Gopal Taori
  • David Pilcher
  • Paul Young
  • Richard Beasley
Original

DOI: 10.1007/s00134-011-2419-6

Cite this article as:
Eastwood, G., Bellomo, R., Bailey, M. et al. Intensive Care Med (2012) 38: 91. doi:10.1007/s00134-011-2419-6

Abstract

Purpose

Early hyperoxia may be an independent risk factor for mortality in mechanically ventilated intensive care unit (ICU) patients. We examined the relationship between early arterial oxygen tension (PaO2) and in-hospital mortality.

Method

We retrospectively assessed arterial blood gases (ABG) with ‘worst’ alveolar-arterial (A-a) gradient during the first 24 h of ICU admission for all ventilated adult patients from 150 participating ICUs between 2000 and 2009. We used multivariate analysis in all patients and defined subgroups to determine the relationship between PaO2 and mortality. We also studied the relationship between worst PaO2, admission PaO2 and peak PaO2 in a random cohort of patients.

Results

We studied 152,680 patients. Their mean PaO2 was 20.3 kPa (SD 14.6) and mean inspired fraction of oxygen (FiO2) was 62% (SD 26). Worst A-a gradient ABG identified that 49.8% (76,110) had hyperoxia (PaO2 > 16 kPa). Nineteen per cent of patients died in ICU and 26% in hospital. After adjusting for site, Simplified Acute Physiology Score II (SAPS II), age, FiO2, surgical type, Glasgow Coma Scale (GCS) below 15 and year of ICU admission, there was an association between progressively lower PaO2 and increasing in-hospital mortality, but not with increasing levels of hyperoxia. Similar findings were observed with a sensitivity analysis of PaO2 derived from high FiO2 (≥50%) versus low FiO2 (<50%) and in defined subgroups. Worst PaO2 showed a strong correlation with admission PaO2 (r = 0.98) and peak PaO2 within 24 h of admission (r = 0.86).

Conclusion

We found there was an association between hypoxia and increased in-hospital mortality, but not with hyperoxia in the first 24 h in ICU and mortality in ventilated patients. Our findings differ from previous studies and suggest that the impact of early hyperoxia on mortality remains uncertain.

Keywords

Arterial oxygen tensionHyperoxiaMechanical ventilationIntensive careMortality

Abbreviations

ANZ

Australia and New Zealand

ANZICS

Australian and New Zealand Intensive Care Society (ANZICS)

APACHE III

Acute Physiology and Chronic Health Evaluation III

CORE

Centre for Outcomes and Resource Evaluation

FiO2

Inspired fraction of oxygen

PaO2

Arterial oxygen tension

SAPS

Simplified Acute Physiology Score

Supplementary material

134_2011_2419_MOESM1_ESM.doc (388 kb)
Supplementary material 1 (DOC 387 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Glenn Eastwood
    • 1
  • Rinaldo Bellomo
    • 1
  • Michael Bailey
    • 2
  • Gopal Taori
    • 3
  • David Pilcher
    • 4
    • 5
  • Paul Young
    • 6
  • Richard Beasley
    • 6
  1. 1.Austin Health, Department of Intensive CareHeidelbergAustralia
  2. 2.Monash University, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive MedicineMelbourneAustralia
  3. 3.Department of Intensive CareMonash Medical CentreClaytonAustralia
  4. 4.Clinical Outcomes and Resource Evaluation (CORE) CentreVictoriaAustralia
  5. 5.Department of Intensive CareAustralia and New Zealand Intensive Care Society (ANZICS); The Alfred HospitalMelbourneAustralia
  6. 6.Wellington Regional Hospital, Medical Research Institute of New ZealandWellingtonNew Zealand