Controversy exists on the role of
hyperoxia in major
trauma with
brain injury.
Hyperoxia on arterial blood gas has been associated with
acute lung injury and pulmonary complications, impacting clinical outcome. The
hyperoxia could be reflective of the physiological interventions following major systemic
trauma. Despite the standard
resuscitation of patients with acute
traumatic brain injury, up to 60% demonstrate low brain
oxygen upon admission to the ICU. While eubaric
hyperoxia has been beneficial in experimental studies, clinical brain
oxygen protocols incorporating intracranial pressure control, maintenance of cerebral perfusion pressure, and the effective use of fraction of inspired
oxygen adjustments to maintain cerebral oxygenation levels >20 to 25 mmHg have demonstrated mortality reductions and improved clinical outcomes. The risk of low brain
oxygen is most acute in the first 24 to 48 hours after injury. The administration of a high fraction of inspired
oxygen (0.6 to 1.0) in the emergency room may be justifiable until ICU admission for the placement of invasive neurocritical care monitoring systems. Thereafter, fraction of inspired
oxygen levels need to be careful titrated to prevent low brain
oxygen levels.