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

Glenn M. Eastwood, Aiko Tanaka, Emilo Daniel Valenzuela Espinoza, Leah Peck, Helen Young, Johan Mårtensson, Ling Zhang, Neil J. Glassford, Yu Feng Frank Hsiao, Satoshi Suzuki, Rinaldo Bellomo

Research output: Contribution to journalArticle

20 Citations (Scopus)

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 FiO2 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).

Original languageEnglish
Pages (from-to)108-114
Number of pages7
JournalResuscitation
Volume101
DOIs
Publication statusPublished - Apr 1 2016
Externally publishedYes

Fingerprint

Heart Arrest
Cohort Studies
Oxygen
Intensive Care Units
Survivors
Conservative Treatment
Hyperoxia
Ventilation
Length of Stay
Gases
Safety

Keywords

  • Cardiac arrest
  • Intensive care
  • Mechanical ventilation
  • Mortality
  • Outcome
  • Oxygen

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Eastwood, G. M., Tanaka, A., Espinoza, E. D. V., Peck, L., Young, H., Mårtensson, J., ... Bellomo, R. (2016). Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study. Resuscitation, 101, 108-114. https://doi.org/10.1016/j.resuscitation.2015.11.026

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

In: Resuscitation, Vol. 101, 01.04.2016, p. 108-114.

Research output: Contribution to journalArticle

Eastwood, GM, Tanaka, A, Espinoza, EDV, Peck, L, Young, H, Mårtensson, J, Zhang, L, Glassford, NJ, Hsiao, YFF, Suzuki, S & Bellomo, R 2016, 'Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study', Resuscitation, vol. 101, pp. 108-114. https://doi.org/10.1016/j.resuscitation.2015.11.026
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. / Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest : A retrospective nested cohort study. In: Resuscitation. 2016 ; Vol. 101. pp. 108-114.
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AU - Eastwood, Glenn M.

AU - Tanaka, Aiko

AU - Espinoza, Emilo Daniel Valenzuela

AU - Peck, Leah

AU - Young, Helen

AU - Mårtensson, Johan

AU - Zhang, Ling

AU - Glassford, Neil J.

AU - Hsiao, Yu Feng Frank

AU - Suzuki, Satoshi

AU - Bellomo, Rinaldo

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AB - 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 FiO2 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).

KW - Cardiac arrest

KW - Intensive care

KW - Mechanical ventilation

KW - Mortality

KW - Outcome

KW - Oxygen

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