Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality.

Abstract

BACKGROUND:

Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no studies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO2) reduces the rate of surgical-wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO2 is associated with risk of death in adult patients with sepsis/septic shock after major surgery.

METHODS:

We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO2 > 100 mmHg (n = 216), or PaO2 ≤ 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS-3 criteria maintained during 48 h. Primary end-point was 90-day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation.

RESULTS:

In patients with PaO2 ≤ 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days, p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90-day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90-day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39-0.95, p = 0.029), independent of age, chronic renal failure, procalcitonin levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded.

CONCLUSIONS:

Oxygenation with a PaO2 above 100 mmHg was independently associated with lower 90-day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO2 in postsurgical patients with severe infections.

• Authors: Marta Martín-Fernández, María Heredia-Rodríguez, Irene González-Jiménez, Mario Lorenzo-López, Estefanía Gómez-Pesquera, Rodrigo Poves-Álvarez, F Javier Álvarez, Pablo Jorge-Monjas, Juan Beltrán-DeHeredia, Eduardo Gutiérrez-Abejón, Francisco Herrera-Gómez, Gabriella Guzzo, Esther Gómez-Sánchez, Álvaro Tamayo-Velasco, Rocío Aller, Paolo Pelosi, Jesús Villar, Eduardo Tamayo
• Journal: Critical care (London, England) (Crit Care) Vol. 26 Issue 1 Pg. 4 (01 10 2022) ISSN: 1466-609X [Electronic] England
• PMID: 35000603 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2022. The Author(s).

Chemical References

• Procalcitonin

Topics

• Adult
• Humans
• Intensive Care Units
• Procalcitonin
• Prognosis
• Prospective Studies
• Sepsis
• Shock, Septic