The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases

Background: Although low oxygen saturations are generally regarded as deleterious, recent studies in ICU patients have shown that a liberal oxygen strategy increases mortality. However, the optimal oxygen saturation target remains unclear. The goal of this study was to determine the optimal range by...

Full description

Saved in:
Bibliographic Details
Main Authors: VAN DEN BOOM, Willem, HOY, Michael, SANKARAN, Jagadish, LIU, Mengru, CHAHED, Haroun, FENG, Mengling, SEE, Kay Choong
Format: text
Language:English
Published: Institutional Knowledge at Singapore Management University 2020
Subjects:
ICU
Online Access:https://ink.library.smu.edu.sg/sis_research/5318
https://ink.library.smu.edu.sg/context/sis_research/article/6321/viewcontent/VanDenBoom_Chest_av_2019.pdf
Tags: Add Tag
No Tags, Be the first to tag this record!
Institution: Singapore Management University
Language: English
id sg-smu-ink.sis_research-6321
record_format dspace
spelling sg-smu-ink.sis_research-63212021-07-01T01:20:15Z The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases VAN DEN BOOM, Willem HOY, Michael SANKARAN, Jagadish LIU, Mengru CHAHED, Haroun FENG, Mengling SEE, Kay Choong Background: Although low oxygen saturations are generally regarded as deleterious, recent studies in ICU patients have shown that a liberal oxygen strategy increases mortality. However, the optimal oxygen saturation target remains unclear. The goal of this study was to determine the optimal range by using real-world data. Methods: Replicate retrospective analyses were conducted of two electronic medical record databases: the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care III database (MIMIC). Only patients with at least 48 h of oxygen therapy were included. Nonlinear regression was used to analyze the association between median pulse oximetry-derived oxygen saturation (SpO2) and hospital mortality. We derived an optimal range of SpO2 and analyzed the association between the percentage of time within the optimal range of SpO2 and hospital mortality. All models adjusted for age, BMI, sex, and Sequential Organ Failure Assessment score. Subgroup analyses included ICU types, main diagnosis, and comorbidities. Results: The analysis identified 26,723 patients from eICU-CRD and 8,564 patients from MIMIC. The optimal range of SpO2 was 94% to 98% in both databases. The percentage of time patients were within the optimal range of SpO2 was associated with decreased hospital mortality (OR of 80% vs 40% of the measurements within the optimal range, 0.42 [95% CI, 0.40-0.43] for eICU-CRD and 0.53 [95% CI, 0.50-0.55] for MIMIC). This association was consistent across subgroup analyses. Conclusions: The optimal range of SpO2 was 94% to 98% and should inform future trials of oxygen therapy. 2020-03-01T08:00:00Z text application/pdf https://ink.library.smu.edu.sg/sis_research/5318 info:doi/10.1016/j.chest.2019.09.015 https://ink.library.smu.edu.sg/context/sis_research/article/6321/viewcontent/VanDenBoom_Chest_av_2019.pdf http://creativecommons.org/licenses/by-nc-nd/4.0/ Research Collection School Of Computing and Information Systems eng Institutional Knowledge at Singapore Management University blood oxygen saturation electronic medical records hyperoxemia ICU oxygen therapy pulse oximetry Databases and Information Systems Medicine and Health Sciences Numerical Analysis and Scientific Computing
institution Singapore Management University
building SMU Libraries
continent Asia
country Singapore
Singapore
content_provider SMU Libraries
collection InK@SMU
language English
topic blood oxygen saturation
electronic medical records
hyperoxemia
ICU
oxygen therapy
pulse oximetry
Databases and Information Systems
Medicine and Health Sciences
Numerical Analysis and Scientific Computing
spellingShingle blood oxygen saturation
electronic medical records
hyperoxemia
ICU
oxygen therapy
pulse oximetry
Databases and Information Systems
Medicine and Health Sciences
Numerical Analysis and Scientific Computing
VAN DEN BOOM, Willem
HOY, Michael
SANKARAN, Jagadish
LIU, Mengru
CHAHED, Haroun
FENG, Mengling
SEE, Kay Choong
The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases
description Background: Although low oxygen saturations are generally regarded as deleterious, recent studies in ICU patients have shown that a liberal oxygen strategy increases mortality. However, the optimal oxygen saturation target remains unclear. The goal of this study was to determine the optimal range by using real-world data. Methods: Replicate retrospective analyses were conducted of two electronic medical record databases: the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care III database (MIMIC). Only patients with at least 48 h of oxygen therapy were included. Nonlinear regression was used to analyze the association between median pulse oximetry-derived oxygen saturation (SpO2) and hospital mortality. We derived an optimal range of SpO2 and analyzed the association between the percentage of time within the optimal range of SpO2 and hospital mortality. All models adjusted for age, BMI, sex, and Sequential Organ Failure Assessment score. Subgroup analyses included ICU types, main diagnosis, and comorbidities. Results: The analysis identified 26,723 patients from eICU-CRD and 8,564 patients from MIMIC. The optimal range of SpO2 was 94% to 98% in both databases. The percentage of time patients were within the optimal range of SpO2 was associated with decreased hospital mortality (OR of 80% vs 40% of the measurements within the optimal range, 0.42 [95% CI, 0.40-0.43] for eICU-CRD and 0.53 [95% CI, 0.50-0.55] for MIMIC). This association was consistent across subgroup analyses. Conclusions: The optimal range of SpO2 was 94% to 98% and should inform future trials of oxygen therapy.
format text
author VAN DEN BOOM, Willem
HOY, Michael
SANKARAN, Jagadish
LIU, Mengru
CHAHED, Haroun
FENG, Mengling
SEE, Kay Choong
author_facet VAN DEN BOOM, Willem
HOY, Michael
SANKARAN, Jagadish
LIU, Mengru
CHAHED, Haroun
FENG, Mengling
SEE, Kay Choong
author_sort VAN DEN BOOM, Willem
title The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases
title_short The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases
title_full The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases
title_fullStr The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases
title_full_unstemmed The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases
title_sort search for optimal oxygen saturation targets in critically ill: patients observational data from large icu databases
publisher Institutional Knowledge at Singapore Management University
publishDate 2020
url https://ink.library.smu.edu.sg/sis_research/5318
https://ink.library.smu.edu.sg/context/sis_research/article/6321/viewcontent/VanDenBoom_Chest_av_2019.pdf
_version_ 1770575400935620608