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High Arterial Oxygen Levels and Supplemental Oxygen Administration in Traumatic Brain Injury: Insights from CENTER-TBI and OzENTER-TBI

By Currents Editor posted 10-11-2022 23:00


Intensive Care Medicine (10/20/22) DOI: 10.1007/s00134-022-06884-x

Rezoagli, Emanuele; Petrosino, Matteo; Rebora, Paola; et al.

Two large, prospective multicenter cohort studies examined if exposure to high blood oxygen levels and high oxygen supplementation were independently associated with outcomes in traumatic brain injury (TBI) patients admitted to the intensive care unit and receiving mechanical ventilation. The studies, conducted in Europe (CENTER-TBI cohort) and Australia (OzENTER-TBI cohort), looked at the arterial partial pressure of oxygen (PaO2) and the oxygen inspired fraction (FiO2) and compared their association within the first week with clinical outcomes. The CENTER-TBI study also sought to determine whether PaO2 and FiO2 levels could have differential relationships with outcome as a result of different levels of brain injury severity, measured by levels of glial fibrillary acidic protein (GFAP) in blood samples taken within 24 hours of injury. Among the 1,084 patients in that cohort, 55% had an unfavorable outcomes and 26% died within a six-month follow-up period. The median PaO2 level was 93-166 mmHg. A factor independently associated with an increased mortality rate were exposure to higher PaO2 and FiO2 in the first week after ICU admission. The OzENTER-TBI study partially confirmed a pattern of a higher mortality rate. Additionally, although GFAP was an independent factor linked to mortality and functional neurologic outcome at follow-up, it did not modulate the outcome impact of increased levels of PaO2. The researchers note that "at minimum, these findings support the need for caution with oxygen therapy in TBI, particularly since titration of supplemental oxygen is immediately applicable at the bedside."


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