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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Hyperoxia is dose-dependently associated with an increase of mortality in ventilated patients with aneurysmal subarachnoid heamorrhage – a retrospective cohort-study

Hyperoxie ist dosisabhängig mit einem Anstieg der Mortalität bei beatmeten Patienten mit aneurysmatischer Subarachnoidalblutung assoziiert – eine retrospektive Kohortenstudie

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  • presenting/speaker Jörn Grensemann - Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
  • Marius Marc-Daniel Mader - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland; Stanford University School of Medicine, Institute for Stem Cell Biology and Regenerative Medicine, Stanford, CA, Vereinigte Staaten
  • Stefan Kluge - Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Patrick Czorlich - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV244

doi: 10.3205/22dgnc236, urn:nbn:de:0183-22dgnc2366

Published: May 25, 2022

© 2022 Grensemann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Adequate oxygenation in patients with aneurysmal subarachnoid hemorrhage (SAH) is imperative. However, hyperoxia increases formation of reactive oxygen species and may be associated with a dose-dependent toxicity. We hypothesized a threshold for oxygen partial pressures (paO2) above which toxicity effects precipitate and sought to study the effects on 30-day mortality, favorable outcome at discharge, and delayed cerebral ischemia (DCI) in an exploratory retrospective single-center cohort study.

Methods: In this retrospective single-center cohort study patients with SAH and mechanical ventilation > 72h were included. Oxygen integrals were calculated above thresholds: 80, 100, 120, and 150mmHg and time-weighted mean paO2 for the first 24h after admission as the hyper-acute phase (d1), from admission to day 3 (d3), and admission to day 14 (d14). Finally, we conducted multivariable logistic regression analyses adjusted for age, sex, duration of ventilation, and Hunt&Hess grade. Favorable outcome was defined as Glasgow Outcome Scale 4 and 5.

Results: From 11/2010 until 02/2021 259 out of 549 patients fulfilled the inclusion criteria. For mortality, no significant association for integrals or mean paO2 on d1 and d3 was found. At d14, odds ratios for mortality increased dose-dependently and were 1.074 (95% confidence intervals: 1.03;1.12; p=0.001) for each 1mmHg per day over 14 days above 80mmHg, 1.183 (1.078;1.298) above 100mmHg, 1.411 (1.176;1.693) above 120mmHg, 1.691 (1.267;2.257) above 150mmHg (all p<0.001), and 1.047 (1.017;1.079) for mean paO2 (p=0.002). No significant association was found for favorable outcome or DCI neither on d1, d3 and d14.

Conclusion: Integrals above defined thresholds were dose-dependently associated with an increase in mortality. Because any hyperoxia above 80mmHg was associated with an increase of mortality, these ranges, otherwise defined as normoxia, should be evaluated in future prospective trials.