Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trial
Abstract Background Criteria for the Sepsis-3 definition of septic shock include vasopressor treatment to maintain a mean arterial pressure > 65 mmHg and a lactate concentration > 2 mmol/L. The impact of hyperoxia in patients with septic shock using these criteria is unknown. Methods A post ho...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-09-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-018-0435-1 |
| _version_ | 1818009223583236096 |
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| author | Julien Demiselle Martin Wepler Clair Hartmann Peter Radermacher Frédérique Schortgen Ferhat Meziani Mervyn Singer Valérie Seegers Pierre Asfar the HYPER2S investigators |
| author_facet | Julien Demiselle Martin Wepler Clair Hartmann Peter Radermacher Frédérique Schortgen Ferhat Meziani Mervyn Singer Valérie Seegers Pierre Asfar the HYPER2S investigators |
| author_sort | Julien Demiselle |
| collection | DOAJ |
| description | Abstract Background Criteria for the Sepsis-3 definition of septic shock include vasopressor treatment to maintain a mean arterial pressure > 65 mmHg and a lactate concentration > 2 mmol/L. The impact of hyperoxia in patients with septic shock using these criteria is unknown. Methods A post hoc analysis was performed of the HYPER2S trial assessing hyperoxia versus normoxia in septic patients requiring vasopressor therapy, in whom a plasma lactate value was available at study inclusion. Mortality was compared between patients fulfilling the Sepsis-3 septic shock criteria and patients requiring vasopressors for hypotension only (i.e., with lactate ≤ 2 mmol/L). Results Of the 434 patients enrolled, 397 had available data for lactate at inclusion. 230 had lactate > 2 mmol/L and 167 ≤ 2 mmol/L. Among patients with lactate > 2 mmol/L, 108 and 122 were “hyperoxia”- and “normoxia”-treated, respectively. Patients with lactate > 2 mmol/L had significantly less COPD more cirrhosis and required surgery more frequently. They also had higher illness severity (SOFA 10.6 ± 2.8 vs. 9.5 ± 2.5, p = 0.0001), required more renal replacement therapy (RRT), and received vasopressor and mechanical ventilation for longer time. Mortality rate at day 28 was higher in the “hyperoxia”-treated patients with lactate > 2 mmol/L as compared to “normoxia”-treated patients (57.4% vs. 44.3%, p = 0.054), despite similar RRT requirements as well as vasopressor and mechanical ventilation-free days. A multivariate analysis showed an independent association between hyperoxia and mortality at day 28 and 90. In patients with lactate ≤ 2 mmol/L, hyperoxia had no effect on mortality nor on other outcomes. Conclusions Our results suggest that hyperoxia may be associated with a higher mortality rate in patients with septic shock using the Sepsis-3 criteria, but not in patients with hypotension alone. |
| first_indexed | 2024-04-14T05:40:13Z |
| format | Article |
| id | doaj.art-6ce492b3e67f430d81ddee5f364c114b |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-14T05:40:13Z |
| publishDate | 2018-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-6ce492b3e67f430d81ddee5f364c114b2022-12-22T02:09:29ZengSpringerOpenAnnals of Intensive Care2110-58202018-09-018111010.1186/s13613-018-0435-1Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trialJulien Demiselle0Martin Wepler1Clair Hartmann2Peter Radermacher3Frédérique Schortgen4Ferhat Meziani5Mervyn Singer6Valérie Seegers7Pierre Asfar8the HYPER2S investigatorsMédecine Intensive et Réanimation, Médecine Hyperbare, Centre Hospitalier UniversitaireInstitut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, UniversitätsklinikumInstitut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, UniversitätsklinikumInstitut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, UniversitätsklinikumService de Réanimation Adulte, Centre Hospitalier Intercommunal de CréteilFaculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA)Bloomsbury Institute of Intensive Care Medicine, University College LondonMédecine Intensive et Réanimation, Médecine Hyperbare, Centre Hospitalier UniversitaireMédecine Intensive et Réanimation, Médecine Hyperbare, Centre Hospitalier UniversitaireAbstract Background Criteria for the Sepsis-3 definition of septic shock include vasopressor treatment to maintain a mean arterial pressure > 65 mmHg and a lactate concentration > 2 mmol/L. The impact of hyperoxia in patients with septic shock using these criteria is unknown. Methods A post hoc analysis was performed of the HYPER2S trial assessing hyperoxia versus normoxia in septic patients requiring vasopressor therapy, in whom a plasma lactate value was available at study inclusion. Mortality was compared between patients fulfilling the Sepsis-3 septic shock criteria and patients requiring vasopressors for hypotension only (i.e., with lactate ≤ 2 mmol/L). Results Of the 434 patients enrolled, 397 had available data for lactate at inclusion. 230 had lactate > 2 mmol/L and 167 ≤ 2 mmol/L. Among patients with lactate > 2 mmol/L, 108 and 122 were “hyperoxia”- and “normoxia”-treated, respectively. Patients with lactate > 2 mmol/L had significantly less COPD more cirrhosis and required surgery more frequently. They also had higher illness severity (SOFA 10.6 ± 2.8 vs. 9.5 ± 2.5, p = 0.0001), required more renal replacement therapy (RRT), and received vasopressor and mechanical ventilation for longer time. Mortality rate at day 28 was higher in the “hyperoxia”-treated patients with lactate > 2 mmol/L as compared to “normoxia”-treated patients (57.4% vs. 44.3%, p = 0.054), despite similar RRT requirements as well as vasopressor and mechanical ventilation-free days. A multivariate analysis showed an independent association between hyperoxia and mortality at day 28 and 90. In patients with lactate ≤ 2 mmol/L, hyperoxia had no effect on mortality nor on other outcomes. Conclusions Our results suggest that hyperoxia may be associated with a higher mortality rate in patients with septic shock using the Sepsis-3 criteria, but not in patients with hypotension alone.http://link.springer.com/article/10.1186/s13613-018-0435-1Septic shockSepsis-3HyperoxiaHyperlactatemiaOxygen transportOxygen extraction |
| spellingShingle | Julien Demiselle Martin Wepler Clair Hartmann Peter Radermacher Frédérique Schortgen Ferhat Meziani Mervyn Singer Valérie Seegers Pierre Asfar the HYPER2S investigators Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trial Annals of Intensive Care Septic shock Sepsis-3 Hyperoxia Hyperlactatemia Oxygen transport Oxygen extraction |
| title | Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trial |
| title_full | Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trial |
| title_fullStr | Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trial |
| title_full_unstemmed | Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trial |
| title_short | Hyperoxia toxicity in septic shock patients according to the Sepsis-3 criteria: a post hoc analysis of the HYPER2S trial |
| title_sort | hyperoxia toxicity in septic shock patients according to the sepsis 3 criteria a post hoc analysis of the hyper2s trial |
| topic | Septic shock Sepsis-3 Hyperoxia Hyperlactatemia Oxygen transport Oxygen extraction |
| url | http://link.springer.com/article/10.1186/s13613-018-0435-1 |
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