Skip to main content
SpringerLink
Log in

Association Between Percutaneous Oxygen Saturation and Mortality of Patients with Mild Traumatic Brain Injury at ICU Admission: An Analysis of the MIMIC-III Database

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Research related to the result of patients with mild traumatic brain injury and the role of percutaneous oxygen saturation (SpO2) level is rarely reported. Our study investigated the relationship between SpO2 and the 30- and 90-day mortality among patients with mild TBI.

Methods

A total of 1027 patients with mild TBI [Glasgow Coma Scale (GCS) > 12] were enrolled from the Medical Information Mart for Intensive Care (MIMIC-III) database. The patients were classified into low-SpO2 (< 95%), moderate-SpO2 (95–98%), and high-SpO2 groups (> 98%). With 30- and 90-day mortality rates as the main outcomes, Cox regression and confined cubic spline models were adopted.

Results

There was a U-shaped curve in confined cubic splines for the relationship between SpO2 and mortality. Compared with the moderate-SpO2 group, the high-SpO2 group exhibited a much higher risk of mortality after modification, with hazard proportions of 2.108 (95% CI 1.211–3.670, P < 0.05) for the 30-day mortality and 1.760 (95% CI 1.140–2.720, P < 0.05) for the 90-day mortality, and the low-SpO2 group exhibited a much higher risk of mortality after modification, with hazard proportions of 2.215 (95% CI 1.194–4.110, P < 0.05) for the 90-day mortality.

Conclusion

Among patients with mild TBI, the correlation between SpO2 level and 30- and 90-day mortality followed a U-shaped curve. Both low and high SpO2 level exerted potential harmful effects on the outcomes of patients with mild TBI. The SpO2 range of 95–98% could be the optimal SpO2 level for mild patients with TBI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Brenner M, Stein D, Hu P, Kufera J, Wooford M, Scalea T. Association between early hyperoxia and worse outcomes after traumatic brain injury. Arch Surg. 2012;147:1042–6.

    Article  PubMed  Google Scholar 

  2. Carney N, Totten A, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80:6–15.

    Article  PubMed  Google Scholar 

  3. Cole T. Global road safety crisis remedy sought: 1.2 million killed, 50 million injured annually. JAMA. 2004;291:2531–2.

    Article  CAS  PubMed  Google Scholar 

  4. Davis DP, Meade W, Sise MJ, et al. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma. 2009;26:2217–23.

    Article  PubMed  Google Scholar 

  5. Ghajar J. Traumatic brain injury. Lancet. 2000;356:923–9.

    Article  CAS  PubMed  Google Scholar 

  6. Girardis M, Busani S, Damiani E, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA. 2016;316:1583–9.

    Article  CAS  PubMed  Google Scholar 

  7. Jubran A. Pulse oximetry. Crit Care. 2015;19:272.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kallet RH, Branson RD. Should oxygen therapy be tightly regulated to minimize hyperoxia in critically ill patients? Respir Care. 2016;61:801–15.

    Article  PubMed  Google Scholar 

  9. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7:728–41.

    Article  PubMed  Google Scholar 

  10. Manning EP. Central nervous system oxygen toxicity and hyperbaric oxygen seizures. Aerosp Med Hum Perform. 2016;87:477–86.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Martin J, Mazer-Amirshahi M, Pourmand A. The impact of hyperoxia in the critically ill patient: a review of the literature. Respir Care. 2020;65:1202–10.

    Article  PubMed  Google Scholar 

  12. McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24:287–93.

    Article  PubMed  Google Scholar 

  13. Miller JD, Sweet RC, Narayan R, Becker DP. Early insults to the injured brain. JAMA. 1978;240:439–42.

    Article  CAS  PubMed  Google Scholar 

  14. O’Driscoll BR, Howard LS, Davison AG, British Thoracic S. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63(Suppl 6):vi1–68.

    PubMed  Google Scholar 

  15. Pan P, Su L, Zhang Q, Long Y, Wang X, Liu D. Effects of quality control targets (SpO2 not equal100%, PaCO2/<40 mmHg, Pmean/>10 cmH2O) on outcomes in patients in the ICU. Front Med (Lausanne). 2020;7:111.

    Article  PubMed  Google Scholar 

  16. Hawryluk G, Rubiano A, Totten A, et al. Guidelines for the management of severe traumatic brain injury: 2020 update of the decompressive craniectomy recommendations. Neurosurgery. 2020;87:427–34.

    Article  PubMed  PubMed Central  Google Scholar 

  17. O’Driscoll BR, Howard LS, Earis J, Mak V. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72:ii1–90.

    Article  CAS  PubMed  Google Scholar 

  18. Siemieniuk RAC, Chu DK, Kim LH, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018;363:k4169.

    Article  PubMed  Google Scholar 

  19. Yang J, Li Y, Liu Q, et al. Brief introduction of medical database and data mining technology in big data era. J Evid Based Med. 2020;13:57–69.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yu Y, Wang J, Wang Q, et al. Admission oxygen saturation and all-cause in-hospital mortality in acute myocardial infarction patients: data from the MIMIC-III database. Ann Transl Med. 2020;8(21):1371.

  21. Sjoberg F, Singer M. The medical use of oxygen: a time for critical reappraisal. J Intern Med. 2013;274:505–28.

    Article  CAS  PubMed  Google Scholar 

  22. Solberg R, Longini M, Proietti F, Vezzosi P, Saugstad OD, Buonocore G. Resuscitation with supplementary oxygen induces oxidative injury in the cerebral cortex. Free Radical Biol Med. 2012;53:1061–7.

    Article  CAS  Google Scholar 

  23. Thomson L, Paton J. Oxygen toxicity. Paediatr Respir Rev. 2014;15:120–3.

    PubMed  Google Scholar 

  24. Vincent J-L, Taccone FS, He X. Harmful effects of hyperoxia in postcardiac arrest, sepsis, traumatic brain injury, or stroke: the importance of individualized oxygen therapy in critically ill patients. Can Respir J. 2017;2017:2834956. https://doi.org/10.1155/2017/2834956.

  25. Rincon F, Kang J, Vibbert M, Urtecho J, Athar MK, Jallo J. Significance of arterial hyperoxia and relationship with case fatality in traumatic brain injury: a multicentre cohort study. J Neurol Neurosurg Psychiatry. 2014;85:799–805.

    Article  PubMed  Google Scholar 

  26. Gennarelli T, Champion H, Sacco W, Copes W, Alves W. Mortality of patients with head injury and extracranial injury treated in trauma centers. J Trauma. 1989;29:1193–201 (discussion 1201–1192).

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Funding

The Natural Science Foundation of Guangdong Province, China (Grant number 2020A1515011249) and the Fundamental Research Funds for the Central Universities of China (Grant number: 21620406) supported this research. The study and the journal’s Rapid Service Fee were funded by Angke Biotechnology Co., Ltd.

Author Contributions

Conception and design: Wei Sun, Yusheng Zhang, Jun Lyu. Acquisition of data: Wei Sun, Ling Wang, Shiqi Yuan, Pingping Song, Rongrong Liu. Statistical analysis: Wei Sun, Shiqi Yuan. Interpretation of data: Wei Sun, Ling Wang, Shiqi Yuan, Wenqiang Che. Drafting the article: Wei Sun. Critically revising the article: Yusheng Zhang, Jiamin Xu. Reviewed and approved the submitted version of manuscript: all authors.

Disclosures

Wei Sun, Yusheng Zhang, Jun Lyu. Ling Wang, Shiqi Yuan, Pingping Song, Rongrong Liu, Wenqiang Che, and Jiamin Xu have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on the MIMIC-III database and does not contain any new studies with human participants or animals performed by any of the authors. Ethical approval and the demand for informed consent were waived for our research. The Massachusetts Institute of Technology (Cambridge, MA) and Beth Israel Deaconess Medical Center (Boston, MA) approved the construction of the MIMIC-III database, and approval was obtained for collecting original information.

Data Availability

All data generated in this study is provided in the results and/or in the supplementary material file.

Author information

Authors and Affiliations

  1. Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, China

    Wei Sun, Ling Wang, Shiqi Yuan, Rongrong Liu, Pingping Song, Jiamin Xu & Yusheng Zhang

  2. Clinical Neuroscience Institute, Jinan University, Guangzhou, China

    Wei Sun, Ling Wang, Rongrong Liu, Pingping Song, Jiamin Xu & Yusheng Zhang

  3. Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China

    Wenqiang Che

  4. Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China

    Shiqi Yuan & Jun Lyu

Authors
  1. Wei Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ling Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiqi Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rongrong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pingping Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wenqiang Che
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiamin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun Lyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yusheng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jun Lyu or Yusheng Zhang.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 28 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, W., Wang, L., Yuan, S. et al. Association Between Percutaneous Oxygen Saturation and Mortality of Patients with Mild Traumatic Brain Injury at ICU Admission: An Analysis of the MIMIC-III Database. Adv Ther 40, 2773–2783 (2023). https://doi.org/10.1007/s12325-023-02499-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-023-02499-w

Keywords

Search

Navigation