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VOLUME 22 , ISSUE 7 ( 2018 ) > List of Articles

RESEARCH ARTICLE

The association between arterial oxygen tension, hemoglobin concentration, and mortality in mechanically ventilated critically ill patients

Mahesh Ramanan, Nick Fisher

Keywords : Anemia, blood gas analysis, critical illness, hypoxia, Intensive Care Units

Citation Information : Ramanan M, Fisher N. The association between arterial oxygen tension, hemoglobin concentration, and mortality in mechanically ventilated critically ill patients. Indian J Crit Care Med 2018; 22 (7):477-484.

DOI: 10.4103/ijccm.IJCCM_66_18

License: CC BY-ND 3.0

Published Online: 01-03-2015

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Background: Hypoxemia and anemia are common findings in critically ill patients admitted to Intensive Care Units. Both are independently associated with significant morbidity and mortality. However, the interaction between oxygenation and anemia and their impact on mortality in critically ill patients has not been clearly defined. We undertook this study to determine whether hemoglobin (Hb) level would modify the association between hypoxemia and mortality in mechanically ventilated critically ill patients. Methods: We performed a retrospective cohort study of all mechanically ventilated adult patients (aged >16 years) in the Australian and New Zealand Intensive Care Society Adult Patient Database (APD) admitted over a 10-year period. Multivariate hierarchical logistic regression was used to assess the relationship between hypoxemia and hospital mortality stratified by Hb. Results: Of 1,196,089 patients in the APD, 219,723 satisfied our inclusion and exclusion criteria. There was a linear negative relationship between hypoxemia and hospital mortality which was significantly modified when stratified by Hb. Hb independently increased the risk of mortality in patients with arterial oxygen tension <102. Conclusions: Hb is an effect modifier on the association between oxygenation and mortality.


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  1. Eastwood G, Bellomo R, Bailey M, Taori G, Pilcher D, Young P, et al. Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Med 2012;38:91-8.
  2. de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, et al. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated Intensive Care Unit patients. Crit Care 2008;12:R156.
  3. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT study: Anemia and blood transfusion in the critically ill – Current clinical practice in the United States. Crit Care Med 2004;32:39-52.
  4. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002;288:1499-507.
  5. Hébert PC, Wells G, Tweeddale M, Martin C, Marshall J, Pham B, et al. Does transfusion practice affect mortality in critically ill patients? Transfusion requirements in critical care (TRICC) investigators and the Canadian critical care trials group. Am J Respir Crit Care Med 1997;155:1618-23.
  6. Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996;348:1055-60.
  7. Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, et al. How is mechanical ventilation employed in the Intensive Care Unit? An international utilization review. Am J Respir Crit Care Med 2000;161:1450-8.
  8. Crapo JD, Hayatdavoudi G, Knapp MJ, Fracica PJ, Wolfe WG, Piantadosi CA, et al. Progressive alveolar septal injury in primates exposed to 60% oxygen for 14 days. Am J Physiol 1994;267:L797-806.
  9. Fracica PJ, Knapp MJ, Piantadosi CA, Takeda K, Fulkerson WJ, Coleman RE, et al. Responses of baboons to prolonged hyperoxia: Physiology and qualitative pathology. J Appl Physiol (1985) 1991;71:2352-62.
  10. Altemeier WA, Sinclair SE. Hyperoxia in the Intensive Care Unit: Why more is not always better. Curr Opin Crit Care 2007;13:73-8.
  11. Damiani E, Adrario E, Girardis M, Romano R, Pelaia P, Singer M, et al. Arterial hyperoxia and mortality in critically ill patients: A systematic review and meta-analysis. Crit Care 2014;18:711.
  12. Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. Amulticenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian critical care trials group. N Engl J Med 1999;340:409-17.
  13. Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 2014;371:1381-91.
  14. Chatterjee S, Wetterslev J, Sharma A, Lichstein E, Mukherjee D. Association of blood transfusion with increased mortality in myocardial infarction: A meta-analysis and diversity-adjusted study sequential analysis. JAMA Intern Med 2013;173:132-9.
  15. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: A systematic review of the literature. Crit Care Med 2008;36:2667-74.
  16. ANZICS Management Committee. ANZICS Centre for Outcome and Resource Evaluation Adult Patient Database (APD) Activity Report 2015-2016; 2016.
  17. Pencina MJ, D'Agostino RB Sr. Evaluating discrimination of risk prediction models: The C statistic. JAMA 2015;314:1063-4.
  18. Meurer WJ, Tolles J. Logistic regression diagnostics: Understanding how well a model predicts outcomes. JAMA 2017;317:1068-9.
  19. Ridler N, Plumb J, Grocott M. Oxygen therapy in critical illness: Friend or foe? A review of oxygen therapy in selected acute illnesses. J Intensive Care Soc 2014;15:190-8.
  20. Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-Lohr V, et al. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999;160:50-6.
  21. Eastwood GM, Reade MC, Peck L, Jones D, Bellomo R. Intensivists' opinion and self-reported practice of oxygen therapy. Anaesth Intensive Care 2011;39:122-6.
  22. O'Driscoll BR, Howard LS, Davison AG; British Thoracic Society. BTS guideline for emergency oxygen use in adult patients. Thorax 2008;63 Suppl 6:vi1-68.
  23. Beasley R, Chien J, Douglas J, Eastlake L, Farah C, King G, et al. Thoracic society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: 'Swimming between the flags'. Respirology 2015;20:1182-91.
  24. Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: Randomised controlled trial. BMJ 2010;341:c5462.
  25. Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, et al. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 2015;131:2143-50.
  26. Zwemer CF, Whitesall SE, D'Alecy LG. Hypoxic cardiopulmonary-cerebral resuscitation fails to improve neurological outcome following cardiac arrest in dogs. Resuscitation 1995;29:225-36.
  27. Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter K, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 2010;303:2165-71.
  28. Girardis M, Busani S, Damiani E, Donati A, Rinaldi L, Marudi A, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an Intensive Care Unit: The oxygen-ICU randomized clinical trial. JAMA 2016;316:1583-9.
  29. Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Høgdall C, Lundvall L, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: The PROXI randomized clinical trial. JAMA 2009;302:1543-50.
  30. Thomas J, Jensen L, Nahirniak S, Gibney RT. Anemia and blood transfusion practices in the critically ill: A prospective cohort review. Heart Lung 2010;39:217-25.
  31. Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001;120:1262-70.
  32. Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 2007;28:2525-38.
  33. Karon BS, Griesmann L, Scott R, Bryant SC, Dubois JA, Shirey TL, et al. Evaluation of the impact of hematocrit and other interference on the accuracy of hospital-based glucose meters. Diabetes Technol Ther 2008;10:111-20.
  34. Rasmussen L, Christensen S, Lenler-Petersen P, Johnsen SP. Anemia and 90-day mortality in COPD patients requiring invasive mechanical ventilation. Clin Epidemiol 2010;3:1-5.
  35. Hayden SJ, Albert TJ, Watkins TR, Swenson ER. Anemia in critical illness: Insights into etiology, consequences, and management. Am J Respir Crit Care Med 2012;185:1049-57.
  36. Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368:11-21.
  37. Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P; Sepsis Occurrence in Acutely Ill Patients (SOAP) Investigators, et al. Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology 2008;108:31-9.
  38. O'Driscoll BR, Howard LS, Bucknall C, Welham SA, Davison AG; British Thoracic Society, et al. British Thoracic Society emergency oxygen audits. Thorax 2011;66:734-5.
  39. Bhatt DL, Mehta C. Adaptive designs for clinical trials. N Engl J Med 2016;375:65-74.
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