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

Author

Willem VAN DEN BOOM, Yale-NUS College
Michael HOY, Nanyang Technological University
Jagadish SANKARAN, National University of Singapore
Mengru LIU, Singapore Management UniversityFollow
Haroun CHAHED, Yale-NUS College
Mengling FENG, National University of Singapore
Kay Choong SEE, National University of Singapore

Publication Type

Journal Article

Version

acceptedVersion

Publication Date

3-2020

Abstract

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.

Keywords

blood oxygen saturation, electronic medical records, hyperoxemia, ICU, oxygen therapy, pulse oximetry

Discipline

Databases and Information Systems | Medicine and Health Sciences | Numerical Analysis and Scientific Computing

Publication

Chest

Volume

157

Issue

3

First Page

566

Last Page

573

ISSN

0012-3692

Identifier

10.1016/j.chest.2019.09.015

Publisher

Elsevier

Embargo Period

10-19-2020

Citation

VAN DEN BOOM, Willem; HOY, Michael; SANKARAN, Jagadish; LIU, Mengru; CHAHED, Haroun; FENG, Mengling; and SEE, Kay Choong. The search for optimal oxygen saturation targets in critically ill: Patients observational data from large ICU databases. (2020). Chest. 157, (3), 566-573.
Available at: https://ink.library.smu.edu.sg/sis_research/5318

Copyright Owner and License

Authors

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Additional URL

https://doi.org/10.1016/j.chest.2019.09.015