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Am J Respir Crit Care Med. 2019 Dec 1;200(11):1373-1380. doi: 10.1164/rccm.201904-0849OC.

The Association between Supraphysiologic Arterial Oxygen Levels and Mortality in Critically Ill Patients. A Multicenter Observational Cohort Study.

Author information

Bloomsbury Institute of Intensive Care Medicine.
INFORM-lab, London, United Kingdom.
Department of Critical Care, Barts Health National Health Service (NHS) Trust, London, United Kingdom.
Research Software Development Group, Research IT Services, and.
Department of Statistical Science, University College London, London, United Kingdom.
Department of Critical Care and.
Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Division of Critical Care, Imperial College Healthcare NHS Trust, London, United Kingdom.
Critical Care Research Group (Kadoorie Centre), Nuffield Department of Clinical Neurosciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
Centre for Human Applied Physiological Science, King's College London, London, United Kingdom.
Department of Surgery and Cancer, Imperial College London, London, United Kingdom; and.
Therapies and Rehabilitation, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Division of Surgery and Interventional Science and.
Critical Care Unit, Royal Free Hospital, London, United Kingdom.


Rationale: There is conflicting evidence on harm related to exposure to supraphysiologic PaO2 (hyperoxemia) in critically ill patients.Objectives: To examine the association between longitudinal exposure to hyperoxemia and mortality in patients admitted to ICUs in five United Kingdom university hospitals.Methods: A retrospective cohort of ICU admissions between January 31, 2014, and December 31, 2018, from the National Institute of Health Research Critical Care Health Informatics Collaborative was studied. Multivariable logistic regression modeled death in ICU by exposure to hyperoxemia.Measurements and Main Results: Subsets with oxygen exposure windows of 0 to 1, 0 to 3, 0 to 5, and 0 to 7 days were evaluated, capturing 19,515, 10,525, 6,360, and 4,296 patients, respectively. Hyperoxemia dose was defined as the area between the PaO2 time curve and a boundary of 13.3 kPa (100 mm Hg) divided by the hours of potential exposure (24, 72, 120, or 168 h). An association was found between exposure to hyperoxemia and ICU mortality for exposure windows of 0 to 1 days (odds ratio [OR], 1.15; 95% compatibility interval [CI], 0.95-1.38; P = 0.15), 0 to 3 days (OR 1.35; 95% CI, 1.04-1.74; P = 0.02), 0 to 5 days (OR, 1.5; 95% CI, 1.07-2.13; P = 0.02), and 0 to 7 days (OR, 1.74; 95% CI, 1.11-2.72; P = 0.02). However, a dose-response relationship was not observed. There was no evidence to support a differential effect between hyperoxemia and either a respiratory diagnosis or mechanical ventilation.Conclusions: An association between hyperoxemia and mortality was observed in our large, unselected multicenter cohort. The absence of a dose-response relationship weakens causal interpretation. Further experimental research is warranted to elucidate this important question.


critical care; hyperoxia; logistic models

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