title: Early-Stage Hyperoxia Is Associated with Favorable Neurological Outcomes and Survival after Severe Traumatic Brain Injury: A Post-Hoc Analysis of the Brain Hypothermia Study.
abstract: The effects of hyperoxia on the neurological outcomes of patients with severe traumatic brain injury (TBI) are still controversial. We examined whether the partial pressure of arterial oxygen (PaO2) and hyperoxia were associated with neurological outcomes and survival by conductingpost-hocanalyses of the Brain Hypothermia (B-HYPO) study, a multi-center randomized controlled trial of mild therapeutic hypothermia for severe TBI. The differences in PaO2and PaO2/fraction of inspiratory oxygen (P/F) ratio on the 1st day of admission were compared between patients with favorable (n= 64) and unfavorable (n= 65) neurological outcomes and between survivors (n= 90) and deceased patients (n= 39). PaO2and the P/F ratio were significantly greater in patients with favorable outcomes than in patients with unfavorable neurological outcomes (PaO2: 252 ± 122 vs. 202 ± 87 mm Hg, respectively,p= 0.008; P/F ratio: 455 ± 171 vs. 389 ± 155, respectively,p= 0.022) and in survivors than in deceased patients (PaO2: 242 ± 117 vs. 193 ± 75 mm Hg, respectively,p= 0.005; P/F ratio: 445 ± 171 vs. 370 ± 141, respectively,p= 0.018). Similar tendencies were observed in subgroup analyses in patients with fever control and therapeutic hypothermia, and in patients with an evacuated mass or other lesions (unevacuated lesions). PaO2was independently associated with survival (odds ratio 1.008,p= 0.037). These results suggested that early-stage hyperoxia might be associated with favorable neurological outcomes and survival following severe TBI.
authors.affiliation: Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Oda
authors.affiliation: Department of Emergency Medicine, Tokuyama Central Hospital, Yamaguchi, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kaneda
authors.affiliation: Emergency and General Medicine, Kumamoto University Hospital, Kumamoto, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.|Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suehiro
authors.affiliation: Department of Emergency and Critical Care Medicine, Showa University Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Dohi
authors.affiliation: Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
authors.affiliation: Osaka Mishima Emergency Critical Care Center, Osaka, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kobata
authors.affiliation: Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tsuruta
authors.affiliation: Yamaguchi Prefectural Grand Medical Center, Yamaguchi, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Maekawa
keywords: P/F ratio; PaO2; TBI; hyperoxia