Normobaric hyperoxia in wartime pediatric trauma casualties

Area of Science:

• Pediatric critical care medicine
• Trauma surgery
• Emergency medicine

Background:

• Hyperoxia therapy is increasingly recognized for potential harm in critically ill patients.
• Pediatric trauma casualties in wartime settings present unique challenges for oxygen management.
• Understanding the impact of oxygen levels on survival is crucial for optimizing care.

Purpose of the Study:

• To investigate the relationship between arterial oxygen levels and survival in pediatric trauma patients.
• To analyze injury characteristics and outcomes stratified by partial pressure of arterial oxygen (PaO2).
• To conduct subgroup analyses for severe traumatic brain injury (TBI) and massive transfusion (MT).

Main Methods:

• Utilized Department of Defense Trauma Registry data from January 2007 to January 2016.
• Included pediatric (<18 years) trauma casualties with available arterial blood gas (ABG) data.
• Stratified patients into normoxemia, hyperoxemia (PaO2 100-300 mmHg), and extreme hyperoxemia (PaO2 >300 mmHg) groups.

Main Results:

• Out of 1323 pediatric trauma patients with ABG, 22% had hyperoxemia and 3.3% had extreme hyperoxemia.
• No significant differences in survival rates were observed between normoxemia, hyperoxemia, and extreme hyperoxemia groups (92% vs. 87% vs. 86%, p=0.078).
• Subgroup analyses for TBI and MT also showed no significant survival differences, and multivariable analyses did not indicate increased odds of survival with higher oxygen levels.

Conclusions:

• Hyperoxemia is a frequent finding in hospitalized pediatric wartime trauma casualties.
• Survival to hospital discharge was not significantly different between pediatric trauma patients with or without hyperoxemia.
• Current findings do not support a detrimental effect of hyperoxemia on survival in this specific cohort.