Early Hyperoxemia and Outcome Among Critically Ill Children.
Early Hyperoxemia and Outcome Among Critically Ill Children.
复制标题
危重儿童的早期高氧血症和结果。
DOI：
10.1097/pcc.0000000000002203
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Horvat,ChristopherM
中科院分区：
文献类型：
--
作者：
Ramgopal,Sriram;Dezfulian,Cameron;Hickey,RobertW;Au,AliciaK;Venkataraman,Shekhar;Clark,RobertSB;Horvat,ChristopherM
目的：确定进入PICU时的高Pa o 2（高血氧血症）是否与住院死亡率相关。设计：单中心观察性研究。设置：四级护理PICU。患者：2009年1月1日至2018年12月31日期间入院的遭遇。干预措施：无。测量和主要结果：包括测量Pa o 2的遭遇。为了说明疾病的严重程度，我们计算了修改后的儿科死亡风险IV评分，不包括每次就诊的Pa o 2，并根据机构数据进行校准。采用逻辑回归分析确定PICU入院前后12小时内的高氧血症（Pao 2≥ 300 kPa [39.99 kPa]）是否与院内死亡率相关。我们重新进行了我们的分析，使用高氧血症的截止值，通过比较观察到的死亡率与预测的死亡率，当遇到最高Pa o 2在50 kPa（6.67 kPa）箱分类。结果报告为校正比值比和95% CI。在23，719次接触中，4，093次在入院后-6至6小时内记录到Pa o 2。4，093例患者中有274例（6.7%）发生院内死亡。高氧血症的患病率随着改良的儿科死亡风险IV的升高而增加，并且在多变量模型中与死亡率无关（校正的比值比，1.38; 95%CI，0.98-1.93）。当使用一个更高的高氧血症临界值时，高氧血症与死亡率相关（校正比值比，2.78; 95%CI，2.54-3.05）。结论：在一个使用校准的急性评分的模型中，在PICU就诊时高氧血症的常规阈值与院内死亡率无关。高氧血症的极端状态（≥ 73.32 kPa）与住院死亡率显著相关。需要进行前瞻性研究以确定PICU入院前和/或入院后的高氧血症是否会导致不良结局。
Objective:To identify whether a high Pa o 2 (hyperoxemia) at the time of presentation to the PICU is associated with in-hospital mortality.Design:Single-center observational study.Setting:Quaternary-care PICU.Patients:Encounters admitted between January 1, 2009, and December 31, 2018.Interventions:None.Measurements and Main Results:Encounters with a measured Pa o 2 were included. To account for severity of illness upon presentation, we calculated a modified Pediatric Risk of Mortality IV score excluding Pa o 2 for each encounter, calibrated for institutional data. Logistic regression was used to determine whether hyperoxemia (Pa o 2≥ 300 torr [39.99 kPa]) in the 12 hours surrounding PICU admission was associated with in-hospital mortality. We reperformed our analysis using a cutoff for hyperoxemia obtained by comparisons of observed versus predicted mortality when encounters were classified by highest Pa o 2 in 50 torr (6.67 kPa) bins. Results are reported as adjusted odds ratios with 95% CIs. Of 23,719 encounters, 4,093 had a Pa o 2 recorded in the period–6 to+ 6 hours after admission. Two hundred seventy-four of 4,093 (6.7%) had in-hospital mortality. The prevalence of hyperoxemia increased with rising modified Pediatric Risk of Mortality IV and was not associated with mortality in multivariable models (adjusted odds ratio, 1.38; 95% CI, 0.98–1.93). When using a higher cutoff of hyperoxemia derived from comparison of observed versus predicted rates of mortality of greater than or equal to 550 torr (73.32 kPa), hyperoxemia was associated with mortality (adjusted odds ratio, 2.78; 95% CI, 2.54–3.05).Conclusions:A conventional threshold for hyperoxemia at presentation to the PICU was not associated with in-hospital mortality in a model using a calibrated acuity score. Extreme states of hyperoxemia (≥ 73.32 kPa) were significantly associated with in-hospital mortality. Prospective research is required to identify if hyperoxemia before and/or after PICU admission contributes to poor outcomes.