Oxygen Exposure Resulting in Arterial Oxygen Tensions Above the Protocol Goal Was Associated With Worse Clinical Outcomes in Acute Respiratory Distress Syndrome.
Oxygen Exposure Resulting in Arterial Oxygen Tensions Above the Protocol Goal Was Associated With Worse Clinical Outcomes in Acute Respiratory Distress Syndrome.
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DOI：
10.1097/ccm.0000000000002886
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发表时间：
2018-04
影响因子：
8.8
通讯作者：
National Institutes of Health Acute Respiratory Distress Syndrome Network Investigators
中科院分区：
文献类型：
--
作者：
Aggarwal NR;Brower RG;Hager DN;Thompson BT;Netzer G;Shanholtz C;Lagakos A;Checkley W;National Institutes of Health Acute Respiratory Distress Syndrome Network Investigators
高FiO 2可加重ARDS患者的肺损伤。参加ARDS网络试验的受试者的目标PaO 2范围为55-80 mmHg，但高于此动脉氧分压范围的氧暴露对临床结局的影响尚不清楚。我们试图确定导致PaO 2高于目标值（>80 mmHg）的氧暴露是否与ARDS患者的不良结局相关。对这些试验中收集的数据进行纵向分析。1996年至2013年间在ARDS网络医院进行的10项临床试验。患有ARDS的危重患者。每天，如果PaO 2>80 mmHg且FiO 2> 0.5，我们确定高于目标的氧暴露，定义为给予的FiO 2与0.5之间的差异，并将前五天的这些值相加。我们确定了在90天出院回家前累积5天高于目标氧暴露对死亡率的影响。在2994例研究入组PaO 2/FiO 2符合ARDS标准的受试者（平均年龄51.3岁，54%为男性）中，平均累积高于目标氧暴露量为0.24 FiO 2-天（四分位数范围0至0.38）。高于目标氧暴露量的参与者更有可能死亡（校正的四分位数范围OR=1.20，95% CI 1.11至1.31），无呼吸机天数较短（校正的四分位数范围平均差异为-0.83，-1.18至-0.48）和无住院天数较短（校正的四分位数范围平均差异为-1.38，-2.09至-0.68）。我们观察到轻度、中度或重度ARDS受试者的累积目标以上氧暴露与临床结局恶化之间存在剂量-反应关系，表明观察到的关系主要不受疾病严重程度的影响。氧暴露导致动脉血氧分压高于方案目标的情况经常发生，并且与所有ARDS严重程度水平的临床结局较差相关。
High FiO2s may augment lung damage to exacerbate lung injury in patients with ARDS. Participants enrolled in ARDS Network Trials had a goal PaO2 range of 55–80 mmHg, yet the effect of oxygen exposure above this arterial oxygen tension range on clinical outcomes is unknown. We sought to determine if oxygen exposure that resulted in a PaO2s above goal (>80 mmHg) was associated with worse outcomes in patients with ARDS. Longitudinal analysis of data collected in these trials. Ten clinical trials conducted at ARDS Network hospitals between 1996 and 2013. Critically ill patients with ARDS. Each day, if the PaO2 >80 mmHg and FiO2 > 0.5, we determined above goal oxygen exposure, defined as the difference between the administered FiO2 and 0.5, and summed these values over the first five days. We determined the effect of a cumulative five-day above goal oxygen exposure on mortality prior to discharge home at 90 days. Among 2994 participants (mean age 51.3 years, 54% male) with a study-entry PaO2/FiO2 that met ARDS criteria, average cumulative above goal oxygen exposure was 0.24 FiO2-days (interquartile range 0 to 0.38). Participants with above goal oxygen exposure were more likely to die (adjusted interquartile-range OR=1.20, 95% CI 1.11 to 1.31), and have lower ventilator-free days (adjusted interquartile-range mean difference of −0.83, −1.18 to −0.48) and lower hospital-free days (adjusted interquartile-range mean difference of −1.38, −2.09 to −0.68). We observed a dose-response relationship between the cumulative above goal oxygen exposure and worsened clinical outcomes for participants with mild, moderate, or severe ARDS, suggesting that the observed relationship is not primarily influenced by severity of illness. Oxygen exposure resulting in arterial oxygen tensions above the protocol goal occurred frequently and was associated with worse clinical outcomes at all levels of ARDS severity.