Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest.
Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest.
复制标题
DOI：
10.1186/s13054-015-1067-6
复制
发表时间：
2015-09-29
期刊：
影响因子：
--
通讯作者：
de Jonge E
中科院分区：
文献类型：
--
作者：
Helmerhorst HJ;Roos-Blom MJ;van Westerloo DJ;Abu-Hanna A;de Keizer NF;de Jonge E
在进入重症监护室（ICU）期间，动脉二氧化碳（PaCO 2）和氧气（PaO 2）浓度可能会显著影响心脏骤停后的器官灌注和结局。我们的目的是调查这两个参数对住院死亡率的独立和协同作用。这是一项队列研究，使用了2007年至2012年荷兰国家重症监护评价（NICE）登记中心中机械通气心脏骤停患者的数据。动脉血气分析中的PaCO 2和PaO 2水平对应于ICU住院前24小时内最差氧合情况，并进行检索分析。进行逻辑回归分析，以评估住院死亡率和两个分类组之间的关系，以及PaCO 2和PaO 2连续值的样条转换。总共纳入了荷兰82个ICU的5，258名心脏骤停患者。在入住ICU的前24小时内，22%的病例出现低碳酸血症，35%的病例出现高碳酸血症。分别有8%和3%的患者观察到缺氧和高氧。PaCO 2和PaO 2与住院死亡率呈独立的U型关系，调整混杂因素后，低碳酸血症和缺氧是住院死亡率的显著预测因子：OR 1.37（95%CI 1.17-1.61）和OR 1.34（95%CI 1.08-1.66）。未观察到PaCO 2和PaO 2同时紊乱的协同效应（P = 0.75）。异常动脉二氧化碳和动脉氧浓度的影响与心脏骤停后的住院死亡率独立相关，但无协同作用。本文的在线版本（doi：10.1186/s13054-015-1067-6）包含补充材料，可供授权用户使用。
Arterial concentrations of carbon dioxide (PaCO2) and oxygen (PaO2) during admission to the intensive care unit (ICU) may substantially affect organ perfusion and outcome after cardiac arrest. Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality. This was a cohort study using data from mechanically ventilated cardiac arrest patients in the Dutch National Intensive Care Evaluation (NICE) registry between 2007 and 2012. PaCO2 and PaO2 levels from arterial blood gas analyses corresponding to the worst oxygenation in the first 24 h of ICU stay were retrieved for analyses. Logistic regression analyses were performed to assess the relationship between hospital mortality and both categorized groups and a spline-based transformation of the continuous values of PaCO2 and PaO2. In total, 5,258 cardiac arrest patients admitted to 82 ICUs in the Netherlands were included. In the first 24 h of ICU admission, hypocapnia was encountered in 22 %, and hypercapnia in 35 % of included cases. Hypoxia and hyperoxia were observed in 8 % and 3 % of the patients, respectively. Both PaCO2 and PaO2 had an independent U-shaped relationship with hospital mortality and after adjustment for confounders, hypocapnia and hypoxia were significant predictors of hospital mortality: OR 1.37 (95 % CI 1.17–1.61) and OR 1.34 (95 % CI 1.08–1.66). A synergistic effect of concurrent derangements of PaCO2 and PaO2 was not observed (P = 0.75). The effects of aberrant arterial carbon dioxide and arterial oxygen concentrations were independently but not synergistically associated with hospital mortality after cardiac arrest. The online version of this article (doi:10.1186/s13054-015-1067-6) contains supplementary material, which is available to authorized users.