Imperial College London

ProfessorStephenBrett

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Critical Care
 
 
 
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Contact

 

+44 (0)20 3313 4521stephen.brett Website

 
 
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Location

 

Hammersmith House 570Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Palmer:2019:10.1164/rccm.201904-0849OC,
author = {Palmer, E and Post, B and Klapaukh, R and Marra, G and MacCallum, NS and Brealey, D and Ercole, A and Jones, A and Ashworth, S and Watkinson, P and Beale, R and Brett, SJ and Young, JD and Black, C and Rashan, A and Martin, D and Singer, M and Harris, S},
doi = {10.1164/rccm.201904-0849OC},
journal = {American Journal of Respiratory and Critical Care Medicine},
pages = {1373--1380},
title = {The association between supra-physiologic arterial oxygen levels and mortality in critically ill patients: a multi-centre observational cohort study},
url = {http://dx.doi.org/10.1164/rccm.201904-0849OC},
volume = {200},
year = {2019}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - Rationale: There is conflicting evidence on harm related to exposure to supra-physiologic arterial oxygen tensions (hyperoxemia) in critically ill patients. Objectives: To examine the association between longitudinal exposure to hyperoxemia and mortality in patients admitted to intensive care units (ICUs) in 5 UK University Hospitals. Methods: Retrospective cohort of ICU admissions between 31st January 2014 - 31st December 2018, from the National Institute of Health Research Critical Care Health Informatics Collaborative (CC-HIC). Multivariable logistic regression modelled death in ICU by exposure to hyperoxemia. Measurements: Subsets with oxygen exposure windows of 0-1, 0-3, 0-5 and 0-7 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 mmHg) divided by the hours of potential exposure (24, 72, 120, or 168 hours). Main Results: An association was found between exposure to hyperoxemia and ICU mortality [odds ratios (95% compatibility intervals); 1.15 (0.95-1.38), p = 0.15; 1.35 (1.04-1.74), p = 0.02; 1.5 (1.07-2.13), p = 0.02; and 1.74 (1.11-2.72), p = 0.02 for exposure windows of 0-1, 0-3, 0-5 and 0-7 days’ duration, respectively. 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.
AU - Palmer,E
AU - Post,B
AU - Klapaukh,R
AU - Marra,G
AU - MacCallum,NS
AU - Brealey,D
AU - Ercole,A
AU - Jones,A
AU - Ashworth,S
AU - Watkinson,P
AU - Beale,R
AU - Brett,SJ
AU - Young,JD
AU - Black,C
AU - Rashan,A
AU - Martin,D
AU - Singer,M
AU - Harris,S
DO - 10.1164/rccm.201904-0849OC
EP - 1380
PY - 2019///
SN - 1073-449X
SP - 1373
TI - The association between supra-physiologic arterial oxygen levels and mortality in critically ill patients: a multi-centre observational cohort study
T2 - American Journal of Respiratory and Critical Care Medicine
UR - http://dx.doi.org/10.1164/rccm.201904-0849OC
UR - https://www.atsjournals.org/doi/10.1164/rccm.201904-0849OC
UR - http://hdl.handle.net/10044/1/74387
VL - 200
ER -