Intensivists’ response to hyperoxemia in mechanical ventilation patients: The status quo and related factors

doi:10.5847/wjem.j.1920-8642.2021.03.007

Abstract

Abstract:

BACKGROUND: Due to the still sparse literature in China, the investigation of hyperoxemia management is required. Thus, we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit (ICU) patients.

METHODS: We retrospectively screened the medical records of adult patients (age ≥18 years) who required mechanical ventilation (MV) ≥24 hours from January 1, 2018, to December 31, 2018. All arterial blood gas (ABG) tested during MV was retrieved, and MV settings were recorded. The median arterial partial pressure of oxygen (PaO₂) >120 mmHg (1 mmHg=0.133 kPa) was defined as mild to moderate hyperoxemia, and PaO₂>300 mmHg as extreme hyperoxemia. Intensivists’ response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen (FiO₂) within one hour after hyperoxemia was recorded. Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’ response to hyperoxemia.

RESULTS: A total of 592 patients were finally analyzed. The median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 21 (15-26). The PaO₂, arterial oxygen saturation (SaO₂), FiO₂, and positive end expiratory pressure (PEEP) were 96.4 (74.0-126.0) mmHg, 97.8% (95.2%-99.1%), 0.4 (0.4-0.5), and 5 (3-6) cmH₂O, respectively. Totally 174 (29.39%) patients had PaO₂ >120 mmHg, and 19 (3.21%) patients had extreme hyperoxemia at PaO₂ >300 mmHg. In cases of mild to moderate hyperoxemia with FiO₂ ≤0.4, only 13 (2.20%) patients had a decrease in FiO₂ within one hour. The multivariable logistic regression analysis showed that a positive response was independently associated with FiO₂ (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.06-1.12, P<0.001), PaO₂ (OR 1.01, 95% CI 1.00-1.01, P=0.002), and working shifts (OR 5.09, 95% CI 1.87-13.80, P=0.001).

CONCLUSIONS: Hyperoxemia occurs frequently and is neglected in most cases, particularly when mild to moderate hyperoxemia, hyperoxemia with lower FiO₂, hyperoxemia during night and middle-night shifts, or FiO₂ less likely to be decreased. Patients may be at a risk of oxygen toxicity because of the liberal oxygen strategy. Therefore, further research is needed to improve oxygen management for patients with MV in the ICUs.

Key words: Mechanical ventilation, Hyperoxemia, Fraction of inspired oxygen, Arterial blood gas, Intensive care unit

Zi-wei Ke, Yue Jiang, Ya-ping Bao, Ye-qin Yang, Xiao-mei Zong, Min Liu, Xiang-yun Guan, Zhong-qiu Lu. Intensivists’ response to hyperoxemia in mechanical ventilation patients: The status quo and related factors[J]. World Journal of Emergency Medicine, 2021, 12(3): 202-206.

Figures/Tables 3

Table 1

Table 2

Table 3

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Variables	Value
Sex (female), n (%)	178 (30.07)
Age, years	63 (50-73)
APACHEII score	21 (15-26)
Reasons for admission, n (%)
Cardiac or vascular disease	79 (13.34)
Thoracic or respiratory disease	74 (12.50)
Neurological disease	178 (30.07)
Gastrointestinal tract disease	58 (9.80)
Trauma	54 (9.12)
Sepsis	54 (9.12)
Other	95 (16.05)
Types of admission, n (%)
Medical	441 (74.49)
Unplanned surgery	92 (15.54)
Planned surgery	59 (9.97)
MV duration, hours	121 (64-236)
Length of ICU stay, days	9 (4-16)
Length of hospital stay, days	17 (8-29)
Oxygenation-related variable
PaO₂, mmHg	96.4 (74.0-126.0)
SaO₂, %	97.8 (95.2-99.1)
FiO₂	0.4 (0.4-0.5)
PEEP, cmH₂O	5 (3-6)

Variables	Positive-response group (n=54)	Negative-response group (n=339)	P-value
Age, years	63 (48-72)	60 (49-71)	0.980
Sex (female), n (%)	17 (31.5)	106 (31.3)	0.370
APACHE II score	22 (17-29)	21 (16-26)	0.900
Type of admission, n (%)			0.450
Medical	38 (70.4)	242 (71.4)
Unplanned surgery	12 (22.2)	57 (16.8)
Planned surgery	4 (7.4)	40 (11.8)
Reasons for admission, n (%)			0.080
Cardiac or vascular disease	10 (18.5)	41 (12.1)
Thoracic or respiratory disease	8 (14.8)	28 (8.3)
Neurological disease	12 (22.2)	116 (34.2)
Gastrointestinal tract disease	1 (1.9)	32 (9.4)
Trauma	9 (16.7)	32 (9.4)
Sepsis	5 (9.3)	30 (8.8)
Others	9 (16.7)	60 (17.7)
The day hyperoxemia occurred after initiation of MV, days	1 (1-1)	2 (1-3)	<0.001
The day hyperoxemia occurred after admission to the ICU, days	1 (1-2)	2 (1-4)	<0.001
Working shifts, n (%)			0.010
Day shift	22 (40.7)	92 (27.1)
Middle-night shift	22 (40.7)	111 (32.7)
Night shift	10 (18.5)	136 (40.1)
pH	7.36 (7.27-7.45)	7.41 (7.35-7.46)	0.020
PEEP, cmH₂O	5 (5-6)	5 (3-5)	0.010
PaCO₂, mmHg	36 (30-43)	34 (30-39)	0.070
PaO₂, mmHg	191 (152-243)	146 (130-170)	<0.001
FiO₂	0.6 (0.5-0.9)	0.4 (0.4-0.5)	<0.001

Variables	Odds ratio (95% CI)	P-value
Night shift	-	0.005
Day shift	5.09 (1.87-13.80)	0.001
Middle-night shift	2.30 (0.84-6.28)	0.110
FiO₂	1.09 (1.06-1.12)	<0.001
PaO₂	1.01 (1.00-1.01)	0.002

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