Association Between Hyperoxia, Supplemental Oxygen, and Mortality in Critically Injured Patients.
Association Between Hyperoxia, Supplemental Oxygen, and Mortality in Critically Injured Patients.
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DOI：
10.1097/cce.0000000000000418
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发表时间：
2021-05
影响因子：
--
通讯作者：
Ginde AA
中科院分区：
文献类型：
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作者：
Douin DJ;Anderson EL;Dylla L;Rice JD;Jackson CL;Wright FL;Bebarta VS;Schauer SG;Ginde AA
补充数字内容可在文本中找到。高氧在危重患者中很常见，可能会增加发病率和死亡率。然而，对于严重受伤的患者，证据有限。本研究的目的是确定高氧与需要入住ICU的成人创伤患者的院内死亡率之间的关系。这项多中心、回顾性队列研究于2015年10月至2018年6月在CO的两个I级创伤中心和一个II级创伤中心进行。所有需要在急诊科到达后24小时内入住ICU的成人创伤患者都符合条件。主要暴露是住院前7天的氧合。没有。主要结局为院内死亡率。次要结局为无住院天数和无呼吸机天数。我们纳入了3，464名重症患者，平均年龄为52.6岁。65%为男性，66%为钝性损伤。264例患者（7.6%）发生了院内死亡的主要结局。在226，057患者小时中，46%处于高氧状态（氧饱和度> 96%），52%处于常氧状态（氧饱和度90-96%）。在高氧期间，调整后的死亡率风险随着给氧量的增加而增加。在氧饱和度为100%时，Fio 2为100%、80%、60%和50%时的死亡率校正风险评分（95% CI）分别为6.4（3.5-11.8）、5.4（3.4-8.6）、2.7（1.7-4.1）和1.5（1.1-2.2）。在血氧饱和度为98%时，Fio 2为100%、80%、60%和50%时的校正死亡风险评分（95% CI）分别为7.7（4.3-13.5）、6.3（4.1-9.7）、3.2（2.2-4.8）和1.9（1.4-2.7）。在高氧期间，给予较高的氧与危重患者的死亡风险增加独立相关。证据等级：队列研究，III级。
Supplemental Digital Content is available in the text. Hyperoxia is common among critically ill patients and may increase morbidity and mortality. However, limited evidence exists for critically injured patients. The objective of this study was to determine the association between hyperoxia and in-hospital mortality in adult trauma patients requiring ICU admission. This multicenter, retrospective cohort study was conducted at two level I trauma centers and one level II trauma center in CO between October 2015 and June 2018. All adult trauma patients requiring ICU admission within 24 hours of emergency department arrival were eligible. The primary exposure was oxygenation during the first 7 days of hospitalization. None. Primary outcome was in-hospital mortality. Secondary outcomes were hospital-free days and ventilator-free days. We included 3,464 critically injured patients with a mean age of 52.6 years. Sixty-five percent were male, and 66% had blunt trauma mechanism of injury. The primary outcome of in-hospital mortality occurred in 264 patients (7.6%). Of 226,057 patient-hours, 46% were spent in hyperoxia (oxygen saturation > 96%) and 52% in normoxia (oxygen saturation 90–96%). During periods of hyperoxia, the adjusted risk for mortality was higher with greater oxygen administration. At oxygen saturation of 100%, the adjusted risk scores for mortality (95% CI) at Fio2 of 100%, 80%, 60%, and 50% were 6.4 (3.5–11.8), 5.4 (3.4–8.6), 2.7 (1.7–4.1), and 1.5 (1.1–2.2), respectively. At oxygen saturation of 98%, the adjusted risk scores for mortality (95% CI) at Fio2 of 100%, 80%, 60%, and 50% were 7.7 (4.3–13.5), 6.3 (4.1–9.7), 3.2 (2.2–4.8), and 1.9 (1.4–2.7), respectively. During hyperoxia, higher oxygen administration was independently associated with a greater risk of mortality among critically injured patients. Level of evidence: Cohort study, level III.