Supplemental oxygen therapy in trauma patients: An exploratory registry-based study

Area of Science:

• Trauma Care
• Critical Care Medicine
• Pulmonary Medicine

Background:

• Supplemental oxygen (SO) is a common intervention in trauma care, often guided by clinical recommendations.
• Limited evidence supports its universal administration, and concerns exist regarding potential harm from excess oxygen, particularly in specific patient groups.
• This study investigates the hypothesis that SO may be detrimental in trauma patients with oxygen saturation exceeding 97%.

Purpose of the Study:

• To evaluate the association between supplemental oxygen administration and in-hospital mortality and acute respiratory distress syndrome (ARDS) in trauma patients.
• To compare outcomes across different ranges of emergency department (ED) oxygen saturation levels.
• To determine if higher oxygen saturation levels exacerbate the risks associated with SO therapy.

Main Methods:

• Analysis of data from the American Trauma Quality Improvement Program 2017 database, including patients receiving SO therapy.
• Categorization of patients into three groups based on ED oxygen saturation: <94%, 94%-97%, and 98%-100%.
• Propensity score matching was employed to compare outcomes (in-hospital mortality and ARDS) between patients who received SO and those who did not within each saturation group.

Main Results:

• A total of 864,340 trauma patients were analyzed. SO administration was significantly associated with an increased risk of in-hospital mortality across all saturation groups (aOR 3.07).
• The risk of mortality was elevated even in patients with lower oxygen saturation (<94%: aOR 2.63; 94%-97%: aOR 2.71) and was highest in those with saturation >97% (aOR 3.38).
• Similarly, SO was linked to a higher incidence of ARDS (aOR 1.79), with the highest risk observed in patients with ED saturation >97% (aOR 2.31).

Conclusions:

• Findings from propensity score-matched registry data indicate that supplemental oxygen administration in trauma patients is associated with increased in-hospital mortality and ARDS.
• The risk of adverse outcomes, including mortality and ARDS, appears to be highest in patients with an emergency department oxygen saturation exceeding 97%.
• These results suggest a potential harm associated with routine or high-concentration supplemental oxygen in certain trauma patient populations, warranting a re-evaluation of current guidelines.