title: Arterial oxygen tension and mortality in mechanically ventilated patients.
abstract: OBJECTIVE
  Early hyperoxia may be an independent risk factor for mortality in mechanically ventilated intensive care unit (ICU) patients. We examined the relationship between early arterial oxygen tension (PaO(2)) and in-hospital mortality.
  
  
  METHODS
  We retrospectively assessed arterial blood gases (ABG) with 'worst' alveolar-arterial (A-a) gradient during the first 24 h of ICU admission for all ventilated adult patients from 150 participating ICUs between 2000 and 2009. We used multivariate analysis in all patients and defined subgroups to determine the relationship between PaO(2) and mortality. We also studied the relationship between worst PaO(2), admission PaO(2) and peak PaO(2) in a random cohort of patients.
  
  
  RESULTS
  We studied 152,680 patients. Their mean PaO(2) was 20.3 kPa (SD 14.6) and mean inspired fraction of oxygen (FiO(2)) was 62% (SD 26). Worst A-a gradient ABG identified that 49.8% (76,110) had hyperoxia (PaO(2) > 16 kPa). Nineteen per cent of patients died in ICU and 26% in hospital. After adjusting for site, Simplified Acute Physiology Score II (SAPS II), age, FiO(2), surgical type, Glasgow Coma Scale (GCS) below 15 and year of ICU admission, there was an association between progressively lower PaO(2) and increasing in-hospital mortality, but not with increasing levels of hyperoxia. Similar findings were observed with a sensitivity analysis of PaO(2) derived from high FiO(2) (≥50%) versus low FiO(2) (<50%) and in defined subgroups. Worst PaO(2) showed a strong correlation with admission PaO(2) (r = 0.98) and peak PaO(2) within 24 h of admission (r = 0.86).
  
  
  CONCLUSIONS
  We found there was an association between hypoxia and increased in-hospital mortality, but not with hyperoxia in the first 24 h in ICU and mortality in ventilated patients. Our findings differ from previous studies and suggest that the impact of early hyperoxia on mortality remains uncertain.
authors: Austin Health, Department of Intensive Care, Heidelberg, Victoria, Australia. glenn.eastwood@austin.org.au
authors: Glenn
authors: G
authors: Eastwood
authors: Rinaldo
authors: R
authors: Bellomo
authors: Michael
authors: M
authors: Bailey
authors: Gopal
authors: G
authors: Taori
authors: David
authors: D
authors: Pilcher
authors: Paul
authors: P
authors: Young
authors: Richard
authors: R
authors: Beasley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D001784:Blood Gas Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018496:Hyperoxia / Q000401:mortality*; D000860:Hypoxia / Q000401:mortality*; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D012121:Respiration, Artificial; D012189:Retrospective Studies