• Neurosurgery · Apr 2016

    Early Moderate Hyperoxemia Does Not Predict Outcome After Aneurysmal Subarachnoid Hemorrhage.

    • Maarit Lång, Rahul Raj, Markus Benedikt Skrifvars, Timo Koivisto, Hanna Lehto, Riku Kivisaari, Mikael von Und Zu Fraunberg, Matti Reinikainen, and Stepani Bendel.
    • *Department of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland; ‡Department of Neurosurgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland; §Division of Intensive Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; ¶Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland; ‖Department of Intensive Care Medicine, North Karelia Central Hospital, Joensuu, Finland.
    • Neurosurgery. 2016 Apr 1; 78 (4): 540-5.

    BackgroundTargeting hyperoxemia is common practice in neurocritical care settings, but the safety of hyperoxemia has been questioned.ObjectiveTo investigate the independent effect of hyperoxemia on outcome in patients with aneurysmal subarachnoid hemorrhage (SAH).MethodsWe included 432 patients with aneurysmal SAH on mechanical ventilation for at least 24 hours after intensive care unit (ICU) admission. Arterial blood gas levels were calculated as time-weighted averages (TWAs) of all blood gas measurements during the first 24 hours in the ICU. Patients were categorized into 3 TWA-PaO2 bands (low, <97.5 mm Hg; intermediate, 97.5-150 mm Hg; high, ≥150 mm Hg). Outcome measures were unfavorable outcome at 3 months (Glasgow Outcome Scale score 1-3) and mortality. Multivariate logistic regression analysis was used to assess the independent effect of oxygen on outcome.ResultsOverall, 28% of patients died, and a total of 53% had an unfavorable outcome at 3 months. Patients with an unfavorable outcome had significantly higher TWA-PaO2 levels compared with patients with a favorable outcome (137 mm Hg vs 118 mm Hg, P < .001). Multivariate analysis demonstrated no significant association between TWA-PaO2 bands and unfavorable outcome (with intermediate PaO2 as a reference, odds ratio [OR] for low PaO2 1.05, 95% confidence interval [CI]: 0.52-2.12, P = .89; OR for high PaO2: 1.09, 95% CI: 0.61-1.97, P = .77) or mortality (with intermediate PaO2 as reference, the OR for low PaO2 was 0.67 (95% CI: 0.30-1.46, P = .31), and the OR for high PaO2 was 0.73 (95% CI: 0.38-1.40, P = .34).ConclusionEarly moderate hyperoxemia may not increase or decrease the risk of a poor outcome in mechanically ventilated aneurysmal SAH patients.

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