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Hyperoxia and Traumatic Brain Injury:  Comment on “Early Hyperoxia Worsens Outcomes After Traumatic Brain Injury”

H. Gill Cryer, MD, PhD
Arch Surg. 2012;147(11):1046. doi:10.1001/archsurg.2012.1641.
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Brenner and colleagues1 have nicely shown that average PaO2 levels of less than 100 mm Hg or greater than 200 mm Hg are independently associated with higher mortality and worse discharge Glasgow Coma Scale scores in 1547 patients with a brain Abbreviated Injury Score of 3 or greater after risk adjusting for mechanism of injury, age, Injury Severity Score, sex, and admission Glasgow Coma Scale score. It has been well established that hypoxia is detrimental to outcome in brain injury. Because of this, there may be a tendency to give higher levels of oxygen to prevent hypoxia. Indeed, the authors found that 43% of their patients had PaO2 values greater than 200 mm Hg in the first 24 hours of care. Unfortunately, this hyperoxia appears to be detrimental to outcome compared with normoxia and is just as bad as hypoxia. If true, these are important findings that could change the way we approach patients with traumatic brain injury.

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