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Both Hypoxemia and Extreme Hyperoxemia May Be Detrimental in Patients with Severe Traumatic Brain Injury

Davis, Daniel P., Meade, William, Sise, Michael J., Kennedy, Frank, Simon, Fred, Tominaga, Gail, Steele, John, Coimbra, Raul·2009·Journal of Neurotrauma

Abstract

An association between hypoxemia and poor outcomes from traumatic brain injury (TBI) is well documented. However, it is unclear whether hyperoxygenation is beneficial. This registry-based analysis explores the relationship between early hypoxemia and hyperoxemia on outcome from moderate-to-severe TBI. TBI patients (Abbreviated Injury Scale score 3+) were identified from the San Diego County trauma registry. Patients were stratified by arrival partial oxygen pressure (Po(2)) value. Trauma and injury severity score (TRISS) was then used to calculate predicted survival for each patient, with the mean observed-predicted survival differential determined for each arrival Po(2) stratification. Logistic regression was used to quantify the relationship between hypoxemia, hyperoxemia, and outcome from TBI after adjusting for multiple variables including intubation and ventilation status. A total of 3420 patients were included in the analysis. TRISS calculations revealed worse outcomes than predicted for both hypoxemia and extreme hyperoxemia. Logistic regression revealed an optimal Po(2) range (110-487 mm Hg), with an independent association observed between decreased survival and both hypoxemia (OR 0.54; 95% CI 0.42, 0.69; p < 0.001) and extreme hyperoxemia (OR 0.50; 95% CI 0.36, 0.71; p < 0.001). The association between hypoxemia and extreme hyperoxemia and worse outcomes was also present with use of "good outcomes" as the outcome variable (discharge to home, rehabilitation, jail, or psychiatric facility, or leaving against medical advice). We conclude that both hypoxemia and extreme hyperoxemia are associated with increased mortality and a decrease in good outcomes among TBI patients.

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Metadata

Authors
Davis, D. P., Meade, W., Sise, M. J., Kennedy, F., Simon, F., Tominaga, G., Steele, J., & Coimbra, R.
Venue
Journal of Neurotrauma
Published
2009-12
Volume
26
Issue
12
Pages
2217-2223
ISSN
  • 0897-7151 (ISSN-L)
  • 1557-9042
OpenAlex
W2027706964
Cited by
271
References
40
FWCI
5.44
Type
journal article
Language
en
Open access
closed

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CoChat. (2026). Citation check: Both Hypoxemia and Extreme Hyperoxemia May Be Detrimental in Patients with Severe Traumatic Brain Injury. https://app.cochat.ai/papers/10.1089/neu.2009.0940
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Davis, D. P., Meade, W., Sise, M. J., Kennedy, F., Simon, F., Tominaga, G., Steele, J., & Coimbra, R. (2009). Both Hypoxemia and Extreme Hyperoxemia May Be Detrimental in Patients with Severe Traumatic Brain Injury. Journal of Neurotrauma. https://doi.org/10.1089/neu.2009.0940

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.