Excess oxygen administration and adverse outcomes in patients with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation: a retrospective study
Critical Care
; 26(SUPPL 1), 2022.
Article
in English
| EMBASE | ID: covidwho-1793894
ABSTRACT
Introduction:
Even if life-saving in most cases, excess O2 may have adverse effects. We described the prevalence of hyperoxemia and excess O2 administration in patients with severe acute respiratory syndrome due to novel coronavirus (SARS-CoV-2) and explored the association with mortality in the intensive care unit (ICU) or ventilatorassociated pneumonia (VAP).Methods:
Retrospective single-centre study on 134 patients with SARS-CoV-2 requiring mechanical ventilation for ≥ 48 h. We calculated the excess O2 administered based on an ideal arterial O2 tension ( PaO2) target of 55-80 mmHg. We defined hyperoxemia as PaO2 > 100 mmHg and hyperoxia + hyperoxemia as an inspired O2 fraction (FiO2) > 60% + PaO2 > 100 mmHg. Risk factors for ICU-mortality and VAP were assessed with multivariate analyses.Results:
Each patient received an excess O2 of 1121 [829-1449] l per day of mechanical ventilation. Hyperoxemia was found in 38 [27-55] % of arterial blood gases, hyperoxia + hyperoxemia in 11 [5-18] %. The FiO2 was not reduced in 69 [62-76] % of cases of hyperoxemia. Adjustments were more frequent with higher PaO2 or initial FiO2 levels. ICU-mortality was 32%. VAP was diagnosed in 48.5% of patients. Hyperoxemia (odds ratio [OR] 1.300 95% confidence interval [1.097- 1.542]) and hyperoxia + hyperoxemia (OR 1.144 [1.008-1.298]) were associated with higher risk for ICU-mortality, independently of age, Sequential Organ failure Assessment score at ICU-admission and mean PaO2/FiO2. Hyperoxemia (OR 1.033 [1.006-1.061]), hyperoxia + hyperoxemia (OR 1.038 [1.003-1.075]) and daily excess O2 (OR 1.001 [1.000- 1.001]) were identified as risk factors for VAP, independently of body mass index, blood transfusions, days of neuromuscular blocking agents before VAP, prolonged prone positioning and mean PaO2/FiO2 before VAP.Conclusions:
Excess O2 administration and hyperoxemia were common in mechanically ventilated patients with SARS-CoV-2 and may be associated with ICU-mortality and greater risk for VAP.
neuromuscular blocking agent; oxygen; adult; adverse device effect; adverse drug reaction; adverse outcome; arterial oxygen tension; artificial ventilation; blood gas; blood transfusion; body mass; conference abstract; controlled study; coronavirus disease 2019; drug therapy; female; fraction of inspired oxygen; Horowitz index; human; intensive care unit; invasive ventilation; major clinical study; male; mortality; nonhuman; outcome assessment; oxygen therapy; prevalence; retrospective study; risk assessment; risk factor; Sequential Organ Failure Assessment Score; severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; ventilated patient; ventilator associated pneumonia
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Observational study
Language:
English
Journal:
Critical Care
Year:
2022
Document Type:
Article
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