Abstract 1766: Both Hypoxia and Hyperoxia May Be Detrimental in Patients with Severe Traumatic Brain Injury
Background: An association between hypoxia and poor outcomes from traumatic brain injury (TBI) is well documented. Aggressive airway management has been advocated to reverse hypoxia, including intubation and ventilation with 1.0 FiO2. It is unclear whether hyperoxygenation is beneficial with severe TBI.
Objectives: To explore the relationship between early hypoxia and hyperoxia on outcome from TBI.
Methods: TBI patients (head Abbreviated Injury Scale score 3+) were identified from the San Diego County trauma registry. Patients were stratified by arrival pO2 value. TRISS was then used to calculate predicted survival for each patient, and the mean observed-predicted survival differential determined for each pO2 stratification. Finally, logistic regression was used to quantify the relationship between hypoxemia, hyperoxemia, and outcome from TBI after adjusting for multiple variables affecting outcome, including intubation status.
Results: A total of 3515 patients were included in the analysis. TRISS calculations revealed worse outcomes than predicted for both hypoxemic and hyperoxemic patients. Logistic regression revealed an optimal pO2 range (110 – 487 mmHg), with an independent association between increased mortality and both hypoxemia (OR 1.7, 95% CI 1.4 −2.1, p < 0.001) and hyperoxemia (OR 1.9, 95% CI 1.4 −2.6, p <0.001). These associations were present even when intubated and nonintubated patients were analyzed separately.
Conclusions: Both hypoxia and hyperoxia were associated with increased mortality in TBI patients, even after adjusting for multiple factors affecting outcomes.