Nowhere Is Safe: Hospital Location and Hyperoxemia in Early Intubation

Introduction: Studies have shown hyperoxemia in intubated patients is associated with poor outcomes including increased mortality. The location where trauma patients most often experience hyperoxemia has not been well studied. Understanding where in the hospital patients are mostly likely to be exposed to hyperoxemia can allow for targeted quality improvement initiatives to improve the incidence of hyperoxemia.


Methods: This was an institutional review board approved single-institution retrospective review of mechanically ventilated trauma patients between January 1st, 2023 and December 31st, 2024. Patients who expired in the trauma bay or were admitted to the medical ICU were excluded. The primary aims of this study were to determine the incidence of hyperoxemia (defined as PaO2 >100mmHg) within the first 72 hours of admission and to determine the location where hyperoxemia most commonly occurred. Four areas were examined: Emergency Room (ER), Operating Room, (OR), Intensive Care Unit (ICU), and ICU Stepdown Unit.


Results: We present data from 1081 individual ABG results. 638 represent the first ABGs taken after intubation. 188 patients were in OR and had a higher average PaO2 (294mmHg) and a 93% rate of hyperoxemia. 179 patients in the Emergency Room had a higher average PaO2 level (232mmHg) than the 252 patients in the Intensive Care Unit (171mmHg), but a similar percentage of both ICU and ER patients were hyperoxemic (65% and 69%). 19 patients in the ICU Stepdown unit were recorded and had the lowest average PaO2 (116mmHg) and rate of hyperoxia (32%).
443 data points from a third ABG drawn after intubation show similar findings with patients in the OR being more likely to be hyperoxemic (84%) and patients in the ER having higher average PaO2 than those in the ICU (218mmHg, 140mmHg), but similar rates of hyperoxemia (65%, 60%).


Conclusions: The initial rate of hyperoxemia after intubation exceeds 65% in the ER, OR, and ICU and the average PaO2 level in each area is supratherapeutic. Subsequent ABG draws show that this rate is not improved as time passes. While particular focus should be made on patients going to the Operating Room, attention needs to be paid in every area of the hospital where intubated critically ill patients reside in order to mitigate the rate of hyperoxemia.