Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study
Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study
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DOI：
10.1186/s13054-017-1926-4
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发表时间：
2018-01-18
期刊：
影响因子：
15.1
通讯作者：
Fuller, Brian M.
中科院分区：
文献类型：
--
作者：
Page, David;Ablordeppey, Enyo;Fuller, Brian M.
背景：提供补充氧是机械通气患者管理的基础。越来越多的数据显示，与高氧相关的临床结果更差。然而，这些先前的危重病人的数据并没有集中在气管插管后立即短暂高氧暴露的相关结果。因此，本研究的目的是评估急诊科（ED）孤立的早期高氧暴露对随后在重症监护病房（ICU）机械通气患者临床结果的影响。方法：这是一项在美国某学术中心的急诊科和icu进行的观察性队列研究。本文研究了ICU患者在急诊科开始机械通气的常压（动脉氧分压）60-120 mm Hg。根据ED插管后获得的PaO2值，将该队列分为缺氧、常氧和高氧三个氧暴露组（根据既往文献，分别定义为PaO2 < 60 mmHg、PaO2 60-120 mmHg和PaO2 bb0 120 mmHg）。结果：共纳入688例患者。350例（50.9%）患者发生ED缺氧，300例（43.6%）患者暴露于ED高氧。ED高氧组ED PaO2中位数（IQR）为189 mm Hg(146-249)，而常氧组ED PaO2为88 mm Hg (76-101), P < 0.001。ED高氧患者的住院死亡率（29.7%）高于正常氧合患者（19.4%）和低氧患者（13.2%）。经多变量logistic回归分析，ED高氧是住院死亡率的独立预测因子（调整OR为1.95(1.34-2.85)）。结论：ED暴露于高氧是常见的，并且与入院后达到正常氧合的机械通气患者死亡率增加有关。这表明，插管后立即出现的高氧可能特别有害，从机械通气开始瞄准正常氧合可能会改善结果。
Background: Providing supplemental oxygen is fundamental in the management of mechanically ventilated patients. Increasing amounts of data show worse clinical outcomes associated with hyperoxia. However, these previous data in the critically ill have not focused on outcomes associated with brief hyperoxia exposure immediately after endotracheal intubation. Therefore, the objectives of this study were to evaluate the impact of isolated early hyperoxia exposure in the emergency department (ED) on clinical outcomes among mechanically ventilated patients with subsequent normoxia in the intensive care unit (ICU).Methods: This was an observational cohort study conducted in the ED and ICUs of an academic center in the USA. Mechanically ventilated normoxic (partial pressure of arterial oxygen (PaO2) 60-120 mm Hg) ICU patients with mechanical ventilation initiated in the ED were studied. The cohort was categorized into three oxygen exposure groups based on PaO2 values obtained after ED intubation: hypoxia, normoxia, and hyperoxia (defined as PaO2 < 60 mmHg, PaO2 60-120 mm Hg, and PaO2 > 120 mm Hg, respectively, based on previous literature).Results: A total of 688 patients were included. ED normoxia occurred in 350 (50.9%) patients, and 300 (43.6%) had exposure to ED hyperoxia. The ED hyperoxia group had a median (IQR) ED PaO2 of 189 mm Hg (146-249), compared toan ED PaO2 of 88 mm Hg (76-101) in the normoxia group, P < 0.001. Patients with ED hyperoxia had greater hospitalmortality (29.7%), when compared to those with normoxia (19.4%) and hypoxia (13.2%). After multivariable logistic regression analysis, ED hyperoxia was an independent predictor of hospital mortality (adjusted OR 1.95 (1.34-2.85)).Conclusions: ED exposure to hyperoxia is common and associated with increased mortality in mechanically ventilated patients achieving normoxia after admission. This suggests that hyperoxia in the immediate post-intubation period could be particularly injurious, and targeting normoxia from initiation of mechanical ventilation may improve outcome.