Information on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes. A post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models. Among 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay. Hyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED. UMIN-CTR, UMIN000019588 . Registered on November 15, 2015.

中文翻译：

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创伤患者复苏期间的高氧血症和重症监护病房住院时间的增加：治疗加权分析的逆概率

除外伤性脑损伤外，关于外伤患者高氧血症的信息有限。本研究旨在阐明创伤患者复苏期间的高氧血症是否与不良结局相关。2016-2018 年在 39 家三级医院对创伤和损伤严重程度评分 (ISS) > 15 的成年患者进行了一项前瞻性观察性研究的事后分析。复苏期间的高氧血症定义为到达医院时 PaO2 ≥ 300 mmHg和/或抵达后 3 小时。比较了高氧血症和非高氧血症患者的重症监护病房 (ICU) 空闲天数。进行了治疗加权逆概率 (IPW) 分析以调整患者特征，包括年龄、损伤机制、合并症、就诊时的生命体征、胸部损伤严重程度和 ISS。根据急诊科 (ED) 的插管状态对分析进行分层。然后用多变量模型分析生物标志物与 ICU 住院时间之间的关联。在登记的 295 名严重受伤的创伤患者中，有 240 名符合分析条件。高氧血症组 (n = 58) 患者的 ICU 空闲天数比非高氧血症组患者短 [17 (10-21) vs 23 (16-26)，p < 0.001]。IPW 分析揭示了高氧血症与未在 ED 插管的患者 ICU 停留时间延长之间的关联 [ICU 空闲天数 = 16 (12-22) 比 23 (19-26)，p = 0.004]，但在ED [18 (9-20) 与 15 (8-23)，p = 0.777]。在高氧血症组中，可溶性 RAGE 和 HMGB-1 等高炎症标志物，以及低肺保护蛋白（如表面活性蛋白 D 和 Clara 细胞分泌蛋白）与 ICU 停留时间延长有关。在未在急诊室插管的严重受伤外伤患者中，到院后 3 小时的高氧血症与 ICU 停留时间延长有关。UMIN-点击率，UMIN000019588。2015 年 11 月 15 日注册。