A new research at the Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet has revealed a surprising discovery. This makes sense if it did not, profound hypoxemia would be fairly common during the initial hours following definitive trauma care. Dr. Oscar Rosenkrantz has piloted a study using CT Imaging in 60 adult patients who experienced trauma crushing injuries. These important findings were published online on March 18, 2015, in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
The study looked at the mechanism of hypoxemia in that all important initial first eight hours of care. Hypoxemia or hypoxic state is defined as an inadequate supply of oxygen in the arterial blood. The original small-scale study included the most diverse set of participants in a major clinical trial to date. Their median age was 49 years and three quarters of them were men.
Study Methodology and Patient Demographics
In this trial, study participants were randomly assigned to receive restrictive versus liberal oxygen therapy. This detailed approach was just one component of a larger analysis called the randomized TRAUMOX2 trial. In one study, researchers noted a median continuous monitoring time of 6.9 hours for their patient cohort. This allowed them to monitor oxygen levels almost in real-time for this critical period.
We found that ≤5% of patients had a median of 17 hours until clinically relevant hypoxemia occurred during the first eight hours of therapy. Importantly, there was no significant difference in rates of hypoxemia amongst those who received restrictive and liberal oxygen strategies.
“These findings suggest that, among trauma patients not already requiring continuous monitoring, such episodes of hypoxemia are relatively rare in the early post-trauma period,” – authors of the study.
Detailed Findings on Hypoxemia Episodes
Of note, this study underscored the fact that episodes of hypoxemia typically occurred during the early resuscitation period. They were done at a timepoint when patients were in the ICU. However, perplexingly, despite similar hypoxemia events in both groups, episodes of hypoxemia were marginally longer in the liberal oxygen group than those in the restrictive arm.
Our researchers discovered that the median difference in episode length was just two seconds (P = .008). This finding indicates limited clinical relevance between the two oxygen therapy approaches. This conclusion underscores that either method of oxygen delivery is capable of providing excellent trauma resuscitation. They are especially important in that early treatment window.
Implications for Trauma Care
The implications of this study are considerable for medical personnel who play a role in trauma. Hypoxemia is uncommon in the acute phase post injury. This rarity can create a false sense of confidence for clinicians in their existing practices of oxygen therapy.
These initial results provide a wealth of information on how to best serve and treat patients. They urge monitoring to continue indefinitely for those at greater risk. As trauma care advances, studies such as this set the groundwork for creating evidence-based practices to help patients achieve the best possible outcome.
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