Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality

• Published in: Critical Care 2022, Vol.26 (1)
• Main Authors: Martín-Fernández, Marta, Heredia-Rodríguez, María, González-Jiménez, Irene, Lorenzo-López, Mario, Gómez-Pesquera, Estefanía, Poves-Ãlvarez, Rodrigo, Ãlvarez, F. Javier, Jorge-Monjas, Pablo, Beltrán-DeHeredia, Juan, Gutiérrez-Abejón, Eduardo, Herrera-Gómez, Francisco, Guzzo, Gabriella, Gómez-Sánchez, Esther, Tamayo-Velasco, Ãlvaro, Aller, Rocío, Pelosi, Paolo, Villar, Jesús, Tamayo, Eduardo
• Format: Report
• Language: English
• Subjects: Complications; Diagnosis; Patient outcomes; Risk factors; Sepsis; Surgery
• ISSN: 1364-8535
• DOI: 10.1186/s13054-021-03875-0

Background Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no studies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO.sub.2) reduces the rate of surgical-wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO.sub.2 is associated with risk of death in adult patients with sepsis/septic shock after major surgery. Methods We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO.sub.2 > 100 mmHg (n = 216), or PaO.sub.2 [less than or equai to] 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS-3 criteria maintained during 48 h. Primary end-point was 90-day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation. Results In patients with PaO.sub.2 [less than or equai to] 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days, p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90-day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90-day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39-0.95, p = 0.029), independent of age, chronic renal failure, procalcitonin levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded. Conclusions Oxygenation with a PaO.sub.2 above 100 mmHg was independently associated with lower 90-day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO.sub.2 in postsurgical patients with severe infections. Keywords: Hyperoxemia, Outcome, Sepsis, Septic Shock, Surgical patients, Infection