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Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy

Intensive Care Medicine, ISSN: 1432-1238, Vol: 46, Issue: 12, Page: 2411-2422
2020
  • 24
    Citations
  • 0
    Usage
  • 76
    Captures
  • 0
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    24
    • Citation Indexes
      23
    • Policy Citations
      1
      • Policy Citation
        1
  • Captures
    76

Article 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 ≥ 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.

Bibliographic Details

Paul Young; Diane Mackle; Rinaldo Bellomo; Michael Bailey; Richard Beasley; Adam Deane; Glenn Eastwood; Simon Finfer; Ross Freebairn; Victoria King; Natalie Linke; Edward Litton; Colin McArthur; Shay McGuinness; Rakshit Panwar; Tanya Baker; Sally Hurford; Mary La Pine; Carla McInnes; Leanlove Navarra; Allison Pritchard; Raulle Sol Cruz; Anne Turner; Tessa Broadley; Dana Lee; Liadain Reid; Lynnette Murray; Aimee Blakemore; Magdalena Butler; Keri-Anne Cowdrey; Eileen Gilder; Jane Hallion; Stephanie Long; Philippa Neal; Rachael Parke; Samantha Wallace; Yan Chen; Rachael McConnochie; Lynette Newby; Catherine Simmonds; David Bowie; Brandon Burke; David Closey; Rosalind Crombie; Neil Davidson; Andrew Greer; Seton Henderson; Louise Hitchings; David Knight; Jan Mehrtens; Kate Miller; Emmeline Minto; Stacey Morgan; Anna Morris; Kim Parker; Jay Ritzema-Carter; Jessica Roberts; Christian Sahl; Geoffrey Shaw; Katherine Townend; Llesley Chadwick; Debra Chalmers; Michael Park; Penelope Park; Christine Rolls; Carmel Chapman; Andrew Stapleton; Jefferson Aguila; Anisha Dias; Alex Kazemi; Vivian Lai; Rima Song; Tony Williams; Sheila Caniba; Maud Carpenter; Rica Dagooc; Danielle Hacking; Ywain Lawrey; Ulrike Buehner; Erin Williams; Jonathan Albrett; Carolyn Jackson; Peter Marko; Ben Barry; Nina Beehre; Dick Dinsdale; Samantha Edney; Frances Fitzjohn; Peter Hicks; Georgia Hill; Anna Hunt; Harriet Judd; Charlotte Latimer-Bell; Cassie Lawrence; Eden Lesona; Agnes McKay-Vucago; Chris Poynter; Alex Psirides; Yvonne Robertson; Hannah Smellie; Shawn Sturland; Bob Ure; Jasmin Board; Aidan Burrell; Tim Byrne; Eliza Dean; Emma Martin; Chris Mason; Phoebe McCracken; Sacha Richardson; Shirley Vallance; Meredith Young; Leah Peck; Helen Young; Ege Eroglu; Edward Litton ame>; Annemarie Palermo; Susan Pellicano; Shailesh Bihari; Xia Jin; Russell Laver; Elisha Matheson; Kate Schwartz; Tapaswi Shrestha; Timothy Beckingham; Natalie Soar; Dhiraj Bhatia; Lauren Bulfin; Timothy Crozier; Klaudija Lavrans; Julie Luong; Venkata Maduri; Michael Patterson; Chloe Peppin; Angela Wang; Catherine Kurenda; Sandra Peake; Nadeem Robaa; Patricia Williams; Lukasz Badek; Stanley Bart; Marianne Chapman; Michael Davies; Sarah Doherty; Kathleen Glasby; Samuel Gluck; Robert Grieve; Palesh Karr; Joanne McIntyre; Stephanie O’Connor; Alexis Poole; Eamon Raith; Benjamin Reddi; Justine Rivett; Sandeep Sethi; Joannies Yap; Nikki Yeo; Yasmine Aliabdelhamind; James Anstey; Deborah Barge; Kathleen Byrne; Paul Emery; Peter Forrest; Madeline Haile; Sandra Lussier; Tom Rechnitzer; Geoffrey Wigmore; Adrian Regli; Leanne Barbazza; Barry Dixon; Jennifer Holmes; John Santamaria; Roger Smith; Antony Tobin

Springer Science and Business Media LLC

Medicine

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