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Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis

  • Yamamoto, Ryo1
  • Fujishima, Seitaro2
  • Sasaki, Junichi1
  • Gando, Satoshi3, 4
  • Saitoh, Daizoh5
  • Shiraishi, Atsushi6
  • Kushimoto, Shigeki7
  • Ogura, Hiroshi8
  • Abe, Toshikazu9, 10
  • Mayumi, Toshihiko11
  • Kotani, Joji12
  • Nakada, Taka-aki13
  • Shiino, Yasukazu14
  • Tarui, Takehiko15
  • Okamoto, Kohji16
  • Sakamoto, Yuichiro17
  • Shiraishi, Shin-Ichiro18
  • Takuma, Kiyotsugu19
  • Tsuruta, Ryosuke20
  • Masuno, Tomohiko21
  • And 8 more
  • 1 Keio University School of Medicine, Tokyo, Japan , Tokyo (Japan)
  • 2 Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan , Tokyo (Japan)
  • 3 Sapporo Higashi Tokushukai Hospital, Sapporo, Japan , Sapporo (Japan)
  • 4 Hokkaido University Graduate School of Medicine, Sapporo, Japan , Sapporo (Japan)
  • 5 National Defense Medical College, Tokorozawa, Japan , Tokorozawa (Japan)
  • 6 Kameda Medical Center, Kameda, Japan , Kameda (Japan)
  • 7 Tohoku University Graduate School of Medicine, Sendai, Japan , Sendai (Japan)
  • 8 Osaka University Graduate School of Medicine, Osaka, Japan , Osaka (Japan)
  • 9 Juntendo University, Tokyo, Japan , Tokyo (Japan)
  • 10 University of Tsukuba, Tsukuba, Japan , Tsukuba (Japan)
  • 11 University of Occupational and Environmental Health, Kitakyushu, Japan , Kitakyushu (Japan)
  • 12 Kobe University Graduate School of Medicine, Kobe, Japan , Kobe (Japan)
  • 13 Chiba University Graduate School of Medicine, Chiba, Japan , Chiba (Japan)
  • 14 Kawasaki Medical School, Kurashiki, Japan , Kurashiki (Japan)
  • 15 Kyorin University School of Medicine, Tokyo, Japan , Tokyo (Japan)
  • 16 Kitakyushu City Yahata Hospital, Kitakyushu, Japan , Kitakyushu (Japan)
  • 17 Saga University Hospital, Saga, Japan , Saga (Japan)
  • 18 Aizu Chuo Hospital, Aizuwakamatsu, Japan , Aizuwakamatsu (Japan)
  • 19 Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan , Kawasaki (Japan)
  • 20 Yamaguchi University Hospital, Ube, Japan , Ube (Japan)
  • 21 Nippon Medical School, Tokyo, Japan , Tokyo (Japan)
  • 22 Aichi Medical University Hospital, Nagakute, Japan , Nagakute (Japan)
  • 23 Kurume University Hospital, Kurume, Japan , Kurume (Japan)
  • 24 Teikyo University School of Medicine, Tokyo, Japan , Tokyo (Japan)
  • 25 Chukyo Hospital, Nagoya, Japan , Nagoya (Japan)
  • 26 St. Luke’s International Hospital, Tokyo, Japan , Tokyo (Japan)
  • 27 Osaka General Medical Center, Osaka, Japan , Osaka (Japan)
  • 28 Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan , Tokyo (Japan)
  • 29 Tokyo Medical and Dental University, Tokyo, Japan , Tokyo (Japan)
Published Article
World Journal of Emergency Surgery
Springer (Biomed Central Ltd.)
Publication Date
Apr 29, 2021
DOI: 10.1186/s13017-021-00363-2
Springer Nature


BackgroundInformation on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes.MethodsA post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models.ResultsAmong 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay.ConclusionsHyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED.Trial registrationUMIN-CTR, UMIN000019588. Registered on November 15, 2015.

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