Variability in targeted arterial oxygenation levels in patients with severe sepsis or septic shock

R. M. Dahl; L. Grønlykke; N. Haase; L. B. Holst; A. Perner; Jørn Wetterslev; B. S. Rasmussen; Christian Sylvest Meyhoff; 6S-Trial and TRISS Trial investigators

doi:10.1111/aas.12528

Variability in targeted arterial oxygenation levels in patients with severe sepsis or septic shock

R. M. Dahl, L. Grønlykke, N. Haase, L. B. Holst, A. Perner, Jørn Wetterslev, B. S. Rasmussen, Christian Sylvest Meyhoff, 6S-Trial and TRISS Trial investigators

Department of Clinical Medicine

11 Citations (Scopus)

Abstract

Background Supplemental oxygen therapy is used for intensive care (ICU) patients with severe sepsis, but with no general guidelines and few safety data. The aim of this observational study was to describe the variability in oxygen administration as well as the association between partial pressure of arterial oxygen (PaO₂) and mortality. Methods We extracted data from two Scandinavian clinical trials of ICU patients with severe sepsis or septic shock. We calculated average PaO₂ and fraction of inspired oxygen (FiO₂) from trial inclusion and the following 5 days, and assessed the association between PaO₂ and 90-day mortality. Results The median PaO₂ was 9.8 kPa [5-95% range 6.4-19.9] and FiO₂ was 0.51 [5-95% range 0.27-1.00], respectively. Eight hundred and five of 1,770 patients (45%) died. The relative risk of mortality was 1.43 [95% CI: 1.19-1.65] in patients with average PaO₂ < 8 kPa and 1.29 [95% CI: 0.84-1.68] in patients with average PaO₂ ≥ 16 kPa, as compared to patients with average PaO₂ 10-12 kPa. The relative risk of mortality was 1.38 [95% CI: 1.17-1.58] in patients with an average FiO₂ 0.60-0.80 and 2.10 [95% CI: 1.88-2.23] in patients with an average FiO₂ ≥ 0.80 as compared to patients with an average FiO₂ ≤ 0.40. Conclusion Administration of oxygen in patients with severe sepsis resulted in a wide range of PaO₂. Significantly higher mortality was observed in patients with an average PaO₂ < 8 kPa and FiO₂ ≥ 0.60. The results do not imply causation and the associations between average PaO₂ and adverse outcomes have to be assessed further.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	59
Issue number	7
Pages (from-to)	859-869
Number of pages	11
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.12528
Publication status	Published - 1 Aug 2015

Keywords

Aged
Blood Gas Analysis
Critical Care
Female
Humans
Male
Middle Aged
Oxygen
Oxygen Inhalation Therapy
Partial Pressure
Scandinavian and Nordic Countries
Sepsis
Shock, Septic

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10.1111/aas.12528

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@article{eba4453cf0ad4ad5b0d271d20980d8cb,

title = "Variability in targeted arterial oxygenation levels in patients with severe sepsis or septic shock",

abstract = "Background Supplemental oxygen therapy is used for intensive care (ICU) patients with severe sepsis, but with no general guidelines and few safety data. The aim of this observational study was to describe the variability in oxygen administration as well as the association between partial pressure of arterial oxygen (PaO2) and mortality. Methods We extracted data from two Scandinavian clinical trials of ICU patients with severe sepsis or septic shock. We calculated average PaO2 and fraction of inspired oxygen (FiO2) from trial inclusion and the following 5 days, and assessed the association between PaO2 and 90-day mortality. Results The median PaO2 was 9.8 kPa [5-95% range 6.4-19.9] and FiO2 was 0.51 [5-95% range 0.27-1.00], respectively. Eight hundred and five of 1,770 patients (45%) died. The relative risk of mortality was 1.43 [95% CI: 1.19-1.65] in patients with average PaO2 < 8 kPa and 1.29 [95% CI: 0.84-1.68] in patients with average PaO2 ≥ 16 kPa, as compared to patients with average PaO2 10-12 kPa. The relative risk of mortality was 1.38 [95% CI: 1.17-1.58] in patients with an average FiO2 0.60-0.80 and 2.10 [95% CI: 1.88-2.23] in patients with an average FiO2 ≥ 0.80 as compared to patients with an average FiO2 ≤ 0.40. Conclusion Administration of oxygen in patients with severe sepsis resulted in a wide range of PaO2. Significantly higher mortality was observed in patients with an average PaO2 < 8 kPa and FiO2 ≥ 0.60. The results do not imply causation and the associations between average PaO2 and adverse outcomes have to be assessed further.",

keywords = "Aged, Blood Gas Analysis, Critical Care, Female, Humans, Male, Middle Aged, Oxygen, Oxygen Inhalation Therapy, Partial Pressure, Scandinavian and Nordic Countries, Sepsis, Shock, Septic",

author = "Dahl, {R. M.} and L. Gr{\o}nlykke and N. Haase and Holst, {L. B.} and A. Perner and J{\o}rn Wetterslev and Rasmussen, {B. S.} and Meyhoff, {Christian Sylvest} and {6S-Trial and TRISS Trial investigators}",

note = "{\textcopyright} 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",

year = "2015",

month = aug,

day = "1",

doi = "10.1111/aas.12528",

language = "English",

volume = "59",

pages = "859--869",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Wiley-Blackwell",

number = "7",

}

TY - JOUR

T1 - Variability in targeted arterial oxygenation levels in patients with severe sepsis or septic shock

AU - Dahl, R. M.

AU - Grønlykke, L.

AU - Haase, N.

AU - Holst, L. B.

AU - Perner, A.

AU - Wetterslev, Jørn

AU - Rasmussen, B. S.

AU - Meyhoff, Christian Sylvest

AU - 6S-Trial and TRISS Trial investigators

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background Supplemental oxygen therapy is used for intensive care (ICU) patients with severe sepsis, but with no general guidelines and few safety data. The aim of this observational study was to describe the variability in oxygen administration as well as the association between partial pressure of arterial oxygen (PaO2) and mortality. Methods We extracted data from two Scandinavian clinical trials of ICU patients with severe sepsis or septic shock. We calculated average PaO2 and fraction of inspired oxygen (FiO2) from trial inclusion and the following 5 days, and assessed the association between PaO2 and 90-day mortality. Results The median PaO2 was 9.8 kPa [5-95% range 6.4-19.9] and FiO2 was 0.51 [5-95% range 0.27-1.00], respectively. Eight hundred and five of 1,770 patients (45%) died. The relative risk of mortality was 1.43 [95% CI: 1.19-1.65] in patients with average PaO2 < 8 kPa and 1.29 [95% CI: 0.84-1.68] in patients with average PaO2 ≥ 16 kPa, as compared to patients with average PaO2 10-12 kPa. The relative risk of mortality was 1.38 [95% CI: 1.17-1.58] in patients with an average FiO2 0.60-0.80 and 2.10 [95% CI: 1.88-2.23] in patients with an average FiO2 ≥ 0.80 as compared to patients with an average FiO2 ≤ 0.40. Conclusion Administration of oxygen in patients with severe sepsis resulted in a wide range of PaO2. Significantly higher mortality was observed in patients with an average PaO2 < 8 kPa and FiO2 ≥ 0.60. The results do not imply causation and the associations between average PaO2 and adverse outcomes have to be assessed further.

AB - Background Supplemental oxygen therapy is used for intensive care (ICU) patients with severe sepsis, but with no general guidelines and few safety data. The aim of this observational study was to describe the variability in oxygen administration as well as the association between partial pressure of arterial oxygen (PaO2) and mortality. Methods We extracted data from two Scandinavian clinical trials of ICU patients with severe sepsis or septic shock. We calculated average PaO2 and fraction of inspired oxygen (FiO2) from trial inclusion and the following 5 days, and assessed the association between PaO2 and 90-day mortality. Results The median PaO2 was 9.8 kPa [5-95% range 6.4-19.9] and FiO2 was 0.51 [5-95% range 0.27-1.00], respectively. Eight hundred and five of 1,770 patients (45%) died. The relative risk of mortality was 1.43 [95% CI: 1.19-1.65] in patients with average PaO2 < 8 kPa and 1.29 [95% CI: 0.84-1.68] in patients with average PaO2 ≥ 16 kPa, as compared to patients with average PaO2 10-12 kPa. The relative risk of mortality was 1.38 [95% CI: 1.17-1.58] in patients with an average FiO2 0.60-0.80 and 2.10 [95% CI: 1.88-2.23] in patients with an average FiO2 ≥ 0.80 as compared to patients with an average FiO2 ≤ 0.40. Conclusion Administration of oxygen in patients with severe sepsis resulted in a wide range of PaO2. Significantly higher mortality was observed in patients with an average PaO2 < 8 kPa and FiO2 ≥ 0.60. The results do not imply causation and the associations between average PaO2 and adverse outcomes have to be assessed further.

KW - Aged

KW - Blood Gas Analysis

KW - Critical Care

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Oxygen

KW - Oxygen Inhalation Therapy

KW - Partial Pressure

KW - Scandinavian and Nordic Countries

KW - Sepsis

KW - Shock, Septic

U2 - 10.1111/aas.12528

DO - 10.1111/aas.12528

M3 - Journal article

C2 - 25914095

SN - 0001-5172

VL - 59

SP - 859

EP - 869

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 7

ER -

Variability in targeted arterial oxygenation levels in patients with severe sepsis or septic shock

Abstract

Keywords

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