PDF(Pubmed)
Abstract：
Although several trials were conducted to optimize the oxygenation range in intensive care unit (ICU) patients, no studies have yet reached a universal recommendation on the optimal a partial pressure of oxygen in arterial blood (PaO2) range in patients with sepsis. Our aim was to evaluate whether a relatively high arterial oxygen tension is associated with longer survival in sepsis patients compared with conservative arterial oxygen tension.
From the Korean Sepsis Alliance nationwide registry, patients treated with liberal PaO2 (PaO2 ≥ 80 mm Hg) were 1:1 matched with those treated with conservative PaO2 (PaO2 < 80 mm Hg) over the first three days after ICU admission according to the propensity score. The primary outcome was 28-day mortality.
The median values of PaO2 over the first three ICU days in 1211 liberal and 1211 conservative PaO2 groups were, respectively, 107.2 (92.0-134.0) and 84.4 (71.2-112.0) in day 1110.0 (93.4-132.0) and 80.0 (71.0-100.0) in day 2, and 106.0 (91.9-127.4) and 78.0 (69.0-94.5) in day 3 (all p-values < 0.001). The liberal PaO2 group showed a lower likelihood of death at day 28 (14.9%; hazard ratio [HR], 0.79; 95% confidence interval [CI] 0.65-0.96; p-value = 0.017). ICU (HR, 0.80; 95% CI 0.67-0.96; p-value = 0.019) and hospital mortalities (HR, 0.84; 95% CI 0.73-0.97; p-value = 0.020) were lower in the liberal PaO2 group. On ICU days 2 (p-value = 0.007) and 3 (p-value < 0.001), but not ICU day 1, hyperoxia was associated with better prognosis compared with conservative oxygenation., with the lowest 28-day mortality, especially at PaO2 of around 100 mm Hg.
In critically ill patients with sepsis, higher PaO2 (≥ 80 mm Hg) during the first three ICU days was associated with a lower 28-day mortality compared with conservative PaO2.
From the Korean Sepsis Alliance nationwide registry, patients treated with liberal PaO2 (PaO2 ≥ 80 mm Hg) were 1:1 matched with those treated with conservative PaO2 (PaO2 < 80 mm Hg) over the first three days after ICU admission according to the propensity score. The primary outcome was 28-day mortality.
The median values of PaO2 over the first three ICU days in 1211 liberal and 1211 conservative PaO2 groups were, respectively, 107.2 (92.0-134.0) and 84.4 (71.2-112.0) in day 1110.0 (93.4-132.0) and 80.0 (71.0-100.0) in day 2, and 106.0 (91.9-127.4) and 78.0 (69.0-94.5) in day 3 (all p-values < 0.001). The liberal PaO2 group showed a lower likelihood of death at day 28 (14.9%; hazard ratio [HR], 0.79; 95% confidence interval [CI] 0.65-0.96; p-value = 0.017). ICU (HR, 0.80; 95% CI 0.67-0.96; p-value = 0.019) and hospital mortalities (HR, 0.84; 95% CI 0.73-0.97; p-value = 0.020) were lower in the liberal PaO2 group. On ICU days 2 (p-value = 0.007) and 3 (p-value < 0.001), but not ICU day 1, hyperoxia was associated with better prognosis compared with conservative oxygenation., with the lowest 28-day mortality, especially at PaO2 of around 100 mm Hg.
In critically ill patients with sepsis, higher PaO2 (≥ 80 mm Hg) during the first three ICU days was associated with a lower 28-day mortality compared with conservative PaO2.
摘要：
尽管进行了几项试验以优化重症监护病房（ICU）患者的氧合范围，尚未有研究就脓毒症患者的最佳动脉血氧分压(PaO2)范围达成普遍建议.我们的目的是评估与保守的动脉血氧分压相比，相对较高的动脉血氧分压是否与脓毒症患者的生存期更长有关。
从韩国脓毒症联盟全国注册，根据倾向评分,接受自由PaO2(PaO2≥80mmHg)治疗的患者在入住ICU后的前3天与接受保守PaO2(PaO2<80mmHg)治疗的患者为1:1.主要结果是28天死亡率。
在1211个自由和1211个保守PaO2组的前3天，PaO2的中值是，分别,第1110.0(93.4-132.0)天107.2(92.0-134.0)和84.4(71.2-112.0),第2天80.0(71.0-100.0),第3天106.0(91.9-127.4)和78.0(69.0-94.5)(所有p值<0.001)。自由PaO2组显示在第28天死亡的可能性较低(14.9%;风险比[HR],0.79；95%置信区间[CI]0.65-0.96；p值=0.017）。ICU(HR,0.80；95%CI0.67-0.96；p值=0.019）和医院死亡率（HR，0.84；95%CI0.73-0.97；p值=0.020）在自由PaO2组中较低。在ICU第2天（p值=0.007）和第3天（p值<0.001），但不是ICU第1天，与保守氧合相比，高氧与更好的预后相关。,28天死亡率最低，尤其是在100mmHg左右的PaO2。
在败血症的危重患者中，与保守性PaO2相比,ICU前3日PaO2较高(≥80mmHg)与28日死亡率较低相关.
从韩国脓毒症联盟全国注册，根据倾向评分,接受自由PaO2(PaO2≥80mmHg)治疗的患者在入住ICU后的前3天与接受保守PaO2(PaO2<80mmHg)治疗的患者为1:1.主要结果是28天死亡率。
在1211个自由和1211个保守PaO2组的前3天，PaO2的中值是，分别,第1110.0(93.4-132.0)天107.2(92.0-134.0)和84.4(71.2-112.0),第2天80.0(71.0-100.0),第3天106.0(91.9-127.4)和78.0(69.0-94.5)(所有p值<0.001)。自由PaO2组显示在第28天死亡的可能性较低(14.9%;风险比[HR],0.79；95%置信区间[CI]0.65-0.96；p值=0.017）。ICU(HR,0.80；95%CI0.67-0.96；p值=0.019）和医院死亡率（HR，0.84；95%CI0.73-0.97；p值=0.020）在自由PaO2组中较低。在ICU第2天（p值=0.007）和第3天（p值<0.001），但不是ICU第1天，与保守氧合相比，高氧与更好的预后相关。,28天死亡率最低，尤其是在100mmHg左右的PaO2。
在败血症的危重患者中，与保守性PaO2相比,ICU前3日PaO2较高(≥80mmHg)与28日死亡率较低相关.
