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Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy
PURPOSE: Liberal use of oxygen may contribute to secondary brain injury in patients with hypoxic-ischaemic encephalopathy (HIE). However, there are limited data on the effect of different oxygen regimens on survival and neurological disability in HIE patients. METHODS: We undertook a post-hoc analys...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431900/ https://www.ncbi.nlm.nih.gov/pubmed/32809136 http://dx.doi.org/10.1007/s00134-020-06196-y |
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author | Young, Paul Mackle, Diane Bellomo, Rinaldo Bailey, Michael Beasley, Richard Deane, Adam Eastwood, Glenn Finfer, Simon Freebairn, Ross King, Victoria Linke, Natalie Litton, Edward McArthur, Colin McGuinness, Shay Panwar, Rakshit |
author_facet | Young, Paul Mackle, Diane Bellomo, Rinaldo Bailey, Michael Beasley, Richard Deane, Adam Eastwood, Glenn Finfer, Simon Freebairn, Ross King, Victoria Linke, Natalie Litton, Edward McArthur, Colin McGuinness, Shay Panwar, Rakshit |
author_sort | Young, Paul |
collection | PubMed |
description | PURPOSE: Liberal use of oxygen may contribute to secondary brain injury in patients with hypoxic-ischaemic encephalopathy (HIE). However, there are limited data on the effect of different oxygen regimens on survival and neurological disability in HIE patients. METHODS: We undertook a post-hoc analysis of the 166 patients with suspected HIE enrolled in a trial comparing conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary endpoint for the current analysis was death or unfavourable neurological outcome at day 180. Key secondary outcomes were day 180 mortality, and cause-specific mortality. RESULTS: Patients with HIE allocated to conservative oxygen spent less time in the ICU with an SpO(2) ≥ 97% (26 h [interquartile range (IQR) 13–45 vs. 35 h [IQR 19–70], absolute difference, 9 h; 95% CI − 21.4 to 3.4). A total of 43 of 78 patients (55.1%) assigned to conservative oxygen and 49 of 72 patients (68.1%) assigned to usual oxygen died or had an unfavourable neurological outcome at day 180; odds ratio 0.58; 95% CI 0.3–1.12; P = 0.1 adjusted odds ratio 0.54; 95% CI 0.23–1.26; P = 0.15. A total of 37 of 86 patients (43%) assigned to conservative oxygen and 46 of 78 (59%) assigned to usual oxygen had died by day 180; odds ratio 0.53; 95% CI 0.28–0.98; P = 0.04; adjusted odds ratio 0.56; 95% CI 0.25–1.23; P = 0.15. Cause-specific mortality was similar by treatment group. CONCLUSIONS: Conservative oxygen therapy was not associated with a statistically significant reduction in death or unfavourable neurological outcomes at day 180. The potential for important benefit or harm from conservative oxygen therapy in HIE patients is not excluded by these data. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06196-y) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7431900 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-74319002020-08-18 Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy Young, Paul Mackle, Diane Bellomo, Rinaldo Bailey, Michael Beasley, Richard Deane, Adam Eastwood, Glenn Finfer, Simon Freebairn, Ross King, Victoria Linke, Natalie Litton, Edward McArthur, Colin McGuinness, Shay Panwar, Rakshit Intensive Care Med Original PURPOSE: Liberal use of oxygen may contribute to secondary brain injury in patients with hypoxic-ischaemic encephalopathy (HIE). However, there are limited data on the effect of different oxygen regimens on survival and neurological disability in HIE patients. METHODS: We undertook a post-hoc analysis of the 166 patients with suspected HIE enrolled in a trial comparing conservative oxygen therapy with usual oxygen therapy in 1000 mechanically ventilated ICU patients. The primary endpoint for the current analysis was death or unfavourable neurological outcome at day 180. Key secondary outcomes were day 180 mortality, and cause-specific mortality. RESULTS: Patients with HIE allocated to conservative oxygen spent less time in the ICU with an SpO(2) ≥ 97% (26 h [interquartile range (IQR) 13–45 vs. 35 h [IQR 19–70], absolute difference, 9 h; 95% CI − 21.4 to 3.4). A total of 43 of 78 patients (55.1%) assigned to conservative oxygen and 49 of 72 patients (68.1%) assigned to usual oxygen died or had an unfavourable neurological outcome at day 180; odds ratio 0.58; 95% CI 0.3–1.12; P = 0.1 adjusted odds ratio 0.54; 95% CI 0.23–1.26; P = 0.15. A total of 37 of 86 patients (43%) assigned to conservative oxygen and 46 of 78 (59%) assigned to usual oxygen had died by day 180; odds ratio 0.53; 95% CI 0.28–0.98; P = 0.04; adjusted odds ratio 0.56; 95% CI 0.25–1.23; P = 0.15. Cause-specific mortality was similar by treatment group. CONCLUSIONS: Conservative oxygen therapy was not associated with a statistically significant reduction in death or unfavourable neurological outcomes at day 180. The potential for important benefit or harm from conservative oxygen therapy in HIE patients is not excluded by these data. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06196-y) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-08-18 2020 /pmc/articles/PMC7431900/ /pubmed/32809136 http://dx.doi.org/10.1007/s00134-020-06196-y Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Young, Paul Mackle, Diane Bellomo, Rinaldo Bailey, Michael Beasley, Richard Deane, Adam Eastwood, Glenn Finfer, Simon Freebairn, Ross King, Victoria Linke, Natalie Litton, Edward McArthur, Colin McGuinness, Shay Panwar, Rakshit Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy |
title | Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy |
title_full | Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy |
title_fullStr | Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy |
title_full_unstemmed | Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy |
title_short | Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy |
title_sort | conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy |
topic | Original |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431900/ https://www.ncbi.nlm.nih.gov/pubmed/32809136 http://dx.doi.org/10.1007/s00134-020-06196-y |
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