Hyperoxia on admission and mortality in patients with sepsis

Abstract

Background: Oxygen therapy is one of the most common interventions in critically ill patients. Although its benefit for reversing hypoxemia is evident, there is an increased risk of hyperoxia and its side effects, especially early after hospital admission.

Objective: To assess the association between hyperoxia at admission and 28-day mortality of patients with sepsis.

Methods: This is a prospective cohort study carried out in the ICU of Hospital Santa Luzia Rede D'Or São Luiz, Brasília - Distrito Federal, which included consecutively admitted patients with sepsis from August 2018 to July 2019. The arterial blood sample was collected at the time of admission. Patients were divided into three groups according to arterial oxygen pressure in arterial blood (PaO2): hypoxia - PaO2 less than 60 mmHg, normoxia - PaO2 between 60 and 100, and hyperoxia - PaO2 above 100 mmHg.

Results: 400 patients were included. Age was 68 ± 21 years, SAPS3: 52 ± 13 and mortality in 28 days: 8.5% (N = 53). Thirty-three patients had hypoxemia on admission (8.3%), 196 normoxemia (49.9%) and 171 hyperoxemia (42.8%). Arterial lactate at admission (2.6 ± 3.0 versus 1.4 ± 1.1, p = 0.012), SAPS 3 (66 ± 16 versus 50 ± 11, p <0.001) and age (75 ± 14 versus 65 ± 22, p = 0.001) were higher in non-surviving patients. Patients with hyperoxemia had higher mortality in 28 days (18.7%) compared to patients with normoxemia (10.7%) and hypoxemia (0.0%), p = 0.040.

Conclusion: Hyperoxia on admission was frequent and was associated with higher mortality in 28 days in critically ill patients with sepsis.