Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study

Abstract Background In mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both. Method...

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Bibliographic Details
Published in:Resuscitation 2016-04, Vol.101, p.108-114
Main Authors: Eastwood, Glenn M, Tanaka, Aiko, Espinoza, Emilo Daniel Valenzuela, Peck, Leah, Young, Helen, Mårtensson, Johan, Zhang, Ling, Glassford, Neil J, Hsiao, Yu-Feng Frank, Suzuki, Satoshi, Bellomo, Rinaldo
Format: Article
Language:English
Subjects:
Aged
Cardiac arrest
Cohort Studies
Conservative Treatment
Emergency
Female
Heart Arrest - therapy
Humans
Intensive care
Male
Mechanical ventilation
Medicin och hälsovetenskap
Middle Aged
Mortality
Outcome
Oxygen
Oxygen Inhalation Therapy
Respiration, Artificial
Retrospective Studies
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Summary:Abstract Background In mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both. Methods We evaluated the introduction of conservative oxygen therapy (target SpO2 88–92% using the lowest FiO2 ) during MV for resuscitated CA patients admitted to the ICU. Results We studied 912 arterial blood gas (ABG) datasets: 448 ABGs from 50 ‘conventional’ and 464 ABGs from 50 ‘conservative’ oxygen therapy patients. Compared to the conventional group, conservative group patients had significantly lower PaO2 values and FiO2 exposure ( p < 0.001, respectively); more received MV in a spontaneous ventilation mode (18% vs 2%; p = 0.001) and more were exposed to a FiO 2 of 0.21 (19 vs 0 patients, p = 0.001). Additionally, according to mean PaO2 , more conservative group patients were classified as normoxaemic (36 vs 16 patients, p < 0.01) and fewer as hyperoxaemic (14 vs 33 patients, p < 0.01). Finally, ICU length of stay was significantly shorter for conservative group patients ( p = 0.04). There was no difference in the proportion of survivors discharged from hospital with good neurological outcome (14/23 vs 12/22 patients, p = 0.67). Conclusions Our findings provide preliminary support for the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU for MV support after cardiac arrest (Trial registration, NCT01684124 ).
ISSN:0300-9572
1873-1570
1873-1570
DOI:10.1016/j.resuscitation.2015.11.026