Maximum Pao2 in the First 72 Hours of Intensive Care Is Associated With Risk-Adjusted Mortality in Pediatric Patients Undergoing Mechanical Ventilation.
Maximum Pao2 in the First 72 Hours of Intensive Care Is Associated With Risk-Adjusted Mortality in Pediatric Patients Undergoing Mechanical Ventilation.
复制标题
重症监护前 72 小时内的最大 Pao2 与接受机械通气的儿科患者的风险调整死亡率相关。
DOI：
10.1097/cce.0000000000000186
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发表时间：
2020
影响因子：
--
通讯作者：
Horvat,ChristopherM
中科院分区：
文献类型：
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作者：
Pelletier,JonathanH;Ramgopal,Sriram;Au,AliciaK;Clark,RobertSB;Horvat,ChristopherM
先前在单中心研究中观察到 Pa o 2 与死亡率之间的关系。我们对儿科健康信息系统及数据库进行了一项回顾性队列研究，研究对象包括入院 72 小时内接受有创通气的内科或心脏 ICU 的 21 岁以下患者。我们训练和验证了一个多变量逻辑回归死亡率预测模型，该模型具有很好的区分度（C 统计量，0.86；95% CI，0.79-0.92；精确回忆曲线下面积，0.39）和可接受的校准（标准化死亡率，0.96；95% CI，0.75-1.23；校准带 p= 0.07）。最大 Pa o 2 测量结果显示与 PICU 死亡率呈抛物线（“U 形”）关系 (Box-Tidwell p< 0.01)。最大 Pa o 2 是风险调整死亡率的统计学显着预测因子（标准化比值比，1.27；95% CI，1.23–1.32；p < 0.001）。该分析是第一项确定 Pa o 2 值极值与 PICU 死亡率之间关系的多中心儿科研究。临床医生在照顾儿童时应谨慎使用氧气。
A relationship between Pa o 2 and mortality has previously been observed in single-center studies. We performed a retrospective cohort study of the Pediatric Health Information System plus database including patients less than or equal to 21 years old admitted to a medical or cardiac ICU who received invasive ventilation within 72 hours of admission. We trained and validated a multivariable logistic regression mortality prediction model with very good discrimination (C-statistic, 0.86; 95% CI, 0.79–0.92; area under the precision-recall curve, 0.39) and acceptable calibration (standardized mortality ratio, 0.96; 95% CI, 0.75–1.23; calibration belt p= 0.07). Maximum Pa o 2 measurements demonstrated a parabolic (“U-shaped”) relationship with PICU mortality (Box-Tidwell p< 0.01). Maximum Pa o 2 was a statistically significant predictor of risk-adjusted mortality (standardized odds ratio, 1.27; 95% CI, 1.23–1.32; p< 0.001). This analysis is the first multicenter pediatric study to identify a relationship between the extremes in Pa o 2 values and PICU mortality. Clinicians should remain judicious in the use of oxygen when caring for children.