Variability in targeted arterial oxygenation levels in patients with severe sepsis or septic shock.
BACKGROUND
Supplemental oxygen therapy is used for intensive care (ICU) patients with severe sepsis, but with no general guidelines and few safety data. The aim of this observational study was to describe the variability in oxygen administration as well as the association between partial pressure of arterial oxygen (PaO2 ) and mortality.


METHODS
We extracted data from two Scandinavian clinical trials of ICU patients with severe sepsis or septic shock. We calculated average PaO2 and fraction of inspired oxygen (FiO2 ) from trial inclusion and the following 5 days, and assessed the association between PaO2 and 90-day mortality.


RESULTS
The median PaO2 was 9.8 kPa [5-95% range 6.4-19.9] and FiO2 was 0.51 [5-95% range 0.27-1.00], respectively. Eight hundred and five of 1,770 patients (45%) died. The relative risk of mortality was 1.43 [95% CI: 1.19-1.65] in patients with average PaO2 < 8 kPa and 1.29 [95% CI: 0.84-1.68] in patients with average PaO2 ≥ 16 kPa, as compared to patients with average PaO2 10-12 kPa. The relative risk of mortality was 1.38 [95% CI: 1.17-1.58] in patients with an average FiO2 0.60-0.80 and 2.10 [95% CI: 1.88-2.23] in patients with an average FiO2  ≥ 0.80 as compared to patients with an average FiO2  ≤ 0.40.


CONCLUSIONS
Administration of oxygen in patients with severe sepsis resulted in a wide range of PaO2 . Significantly higher mortality was observed in patients with an average PaO2 < 8 kPa and FiO2 ≥ 0.60. The results do not imply causation and the associations between average PaO2 and adverse outcomes have to be assessed further.
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
R M
RM
Dahl
Department of Anaesthesiology, Nordsjaellands Hospital - Hillerød, University of Copenhagen, Hillerød, Denmark.
L
L
Grønlykke
Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
N
N
Haase
Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
L B
LB
Holst
Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
A
A
Perner
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark.
J
J
Wetterslev
Department of Anaesthesiology, Aalborg Hospital, University of Aalborg, Aalborg, Denmark.
B S
BS
Rasmussen
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
C S
CS
Meyhoff
D000368:Aged; D001784:Blood Gas Analysis; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood* / Q000627:therapeutic use*; D010102:Oxygen Inhalation Therapy; D010313:Partial Pressure; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D018805:Sepsis / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000401:mortality / Q000628:therapy
D010100:Oxygen