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Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest: A secondary analysis of the TTM-2 trial
F. Sanfilippo, A. Uryga, C. Santonocito, JC. Jakobsen, G. Lilja, H. Friberg, PD. Wendel-Garcia, PJ. Young, G. Eastwood, MS. Chew, J. Unden, M. Thomas, AM. Grejs, MP. Wise, A. Lundin, J. Hollenberg, N. Hammond, M. Saxena, A. Martin, R. Bánszky,...
Jazyk angličtina Země Irsko
Typ dokumentu časopisecké články, randomizované kontrolované studie, multicentrická studie
- MeSH
- časové faktory MeSH
- hyperoxie * komplikace etiologie MeSH
- jednotky intenzivní péče statistika a číselné údaje MeSH
- kardiopulmonální resuscitace * metody MeSH
- kyslík krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- terapeutická hypotermie metody škodlivé účinky MeSH
- zástava srdce mimo nemocnici * terapie mortalita MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
PURPOSE: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear. METHODS: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial. The primary aim was to identify the best cut-off of partial arterial pressure of oxygen (PaO2) to predict poor functional outcome within the first 24 h from admission, with this period further separated into 'very early' (0-4 h), 'early' (8-24 h), and 'late' (28-72 h) periods. Hyperoxemia was defined as the highest PaO2 recorded during each period. Poor functional outcome was defined as a 6 months modified Rankin Score (mRS) of 4 to 6. RESULTS: A total of 1,631 patients were analysed for the 'very early' and 'early' periods, and 1,591 in the 'late period'. In a multivariate logistic regression model, a PaO2 above 245 mmHg during the very early phase was independently associated with a higher probability of poor functional outcome (Odds Ratio, OR = 1.63, 95 % Confidence Interval, CI 1.08-2.44, p = 0.019). No significant associations were found for the later periods. CONCLUSIONS: Very early hyperoxemia after ICU admission is associated with higher risk of poor functional outcome after OHCA. Avoiding hyperoxia in the initial hours after resuscitation should be considered.
Adult Critical Care University Hospital of Wales Cardiff UK
Department of Anaesthesia and Intensive Care A O U Policlinico San Marco Catania Italy
Department of Biomedical Engineering Wroclaw University of Science and Technology Wrocław Poland
Department of Clinical Medicine Anaesthesiology and Intensive Care Lund University Lund Sweden
Department of Clinical Sciences Malmö Lund University Malmö Sweden
Department of Critical Care University of Melbourne Parkville VIC Australia
Department of Intensive Care Austin hospital Melbourne Australia
Department of Intensive Care Medicine Université Libre de Bruxelles Hopital Erasme Bruxelles Belgium
Department of of Clinical Sciences Lund Anesthesia and Intensive Care Lund University Lund Sweden
Department of Operation and Intensive Care Lund University Hallands Hospital Halmstad Halland Sweden
Department of Surgical Sciences and Integrated Diagnostics University of Genoa Genoa Italy
Faculty of Medicine Charles University Hradec Králové Czech Republic
Intensive Care Unit St George Hospital Sydney Australia
Intensive Care Unit Wellington Regional Hospital Wellington New Zealand
Medical Research Institute of New Zealand Private Bag 7902 Wellington 6242 New Zealand
University Hospitals Bristol NHS Foundation Trust Bristol UK
Citace poskytuje Crossref.org
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- $a PURPOSE: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear. METHODS: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial. The primary aim was to identify the best cut-off of partial arterial pressure of oxygen (PaO2) to predict poor functional outcome within the first 24 h from admission, with this period further separated into 'very early' (0-4 h), 'early' (8-24 h), and 'late' (28-72 h) periods. Hyperoxemia was defined as the highest PaO2 recorded during each period. Poor functional outcome was defined as a 6 months modified Rankin Score (mRS) of 4 to 6. RESULTS: A total of 1,631 patients were analysed for the 'very early' and 'early' periods, and 1,591 in the 'late period'. In a multivariate logistic regression model, a PaO2 above 245 mmHg during the very early phase was independently associated with a higher probability of poor functional outcome (Odds Ratio, OR = 1.63, 95 % Confidence Interval, CI 1.08-2.44, p = 0.019). No significant associations were found for the later periods. CONCLUSIONS: Very early hyperoxemia after ICU admission is associated with higher risk of poor functional outcome after OHCA. Avoiding hyperoxia in the initial hours after resuscitation should be considered.
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