Intensive Care Medicine (2020)
18 August
2020
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 SpO2 ≥ 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.
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