Conservative Oxygen Therapy during Mechanical Ventilation in the ICU
Conservative Oxygen Therapy during Mechanical Ventilation in the ICU
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DOI：
10.1056/nejmoa1903297
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发表时间：
2020-03-12
影响因子：
158.5
通讯作者：
Young, Paul
中科院分区：
文献类型：
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作者：
Mackle, Diane;Bellomo, M. N. Rinaldo;Young, Paul
在重症监护室（ICU）接受机械通气的患者通常接受高比例的吸入氧（Fio（2）），并且动脉氧分压较高。氧气的保守使用可能会减少氧气暴露，减少肺和全身氧化损伤，从而增加呼吸机无天数（存活天数和无机械通气）。方法我们随机分配1000例成人患者，预计需要机械通气超过招募后一天在ICU接受保守或常规氧气治疗。在两组中，通过脉搏血氧仪（Spo（2））测量的氧饱和度默认下限为90%。在保守氧组中，当水平达到97%时，Spo（2）警报的上限设置为响起，如果Spo（2）高于可接受的下限，则Fio（2）降至0.21。在常氧组中，没有限制Fio（2）或Spo（2）的特定措施。主要观察指标为从随机分组至第28天的无呼吸机天数。结果保守氧疗组与常氧疗组的无呼吸机天数无显著性差异，中位持续时间为21.3天（四分位距，0 - 26.3）和22.1天（四分位数范围，0至26.2），绝对差异为-0.3天（95%置信区间[CI]，-2.1至1.6; P=0.80）。保守吸氧组在ICU的时间比常规吸氧组长，Fio（2）为0.21，中位持续时间为29小时（四分位数范围，5至78）和1小时（四分位距，0 - 17）（绝对差异，28小时; 95% CI，22 - 34）;氧保护组Spo（2）超过96%的时间更短，持续时间为27小时（四分位距，11至63.5）和49小时（四分位距，22至112）（绝对差异，22小时; 95% CI，14至30）。180天时，保守吸氧组的死亡率为35.7%，常规吸氧组为34.5%，未校正的优势比为1.05结论在ICU接受机械通气的成人中，与常规氧疗相比，对无呼吸机天数无显著影响。（由新西兰健康研究理事会资助; ICU-ROX澳大利亚和新西兰临床试验注册号ACTRN 12615000957594。）
Background Patients who are undergoing mechanical ventilation in the intensive care unit (ICU) often receive a high fraction of inspired oxygen (Fio(2)) and have a high arterial oxygen tension. The conservative use of oxygen may reduce oxygen exposure, diminish lung and systemic oxidative injury, and thereby increase the number of ventilator-free days (days alive and free from mechanical ventilation).Methods We randomly assigned 1000 adult patients who were anticipated to require mechanical ventilation beyond the day after recruitment in the ICU to receive conservative or usual oxygen therapy. In the two groups, the default lower limit for oxygen saturation as measured by pulse oximetry (Spo(2)) was 90%. In the conservative-oxygen group, the upper limit of the Spo(2) alarm was set to sound when the level reached 97%, and the Fio(2) was decreased to 0.21 if the Spo(2) was above the acceptable lower limit. In the usual-oxygen group, there were no specific measures limiting the Fio(2) or the Spo(2). The primary outcome was the number of ventilator-free days from randomization until day 28.Results The number of ventilator-free days did not differ significantly between the conservative-oxygen group and the usual-oxygen group, with a median duration of 21.3 days (interquartile range, 0 to 26.3) and 22.1 days (interquartile range, 0 to 26.2), respectively, for an absolute difference of -0.3 days (95% confidence interval [CI], -2.1 to 1.6; P=0.80). The conservative-oxygen group spent more time in the ICU with an Fio(2) of 0.21 than the usual-oxygen group, with a median duration of 29 hours (interquartile range, 5 to 78) and 1 hour (interquartile range, 0 to 17), respectively (absolute difference, 28 hours; 95% CI, 22 to 34); the conservative-oxygen group spent less time with an Spo(2) exceeding 96%, with a duration of 27 hours (interquartile range, 11 to 63.5) and 49 hours (interquartile range, 22 to 112), respectively (absolute difference, 22 hours; 95% CI, 14 to 30). At 180 days, mortality was 35.7% in the conservative-oxygen group and 34.5% in the usual-oxygen group, for an unadjusted odds ratio of 1.05 (95% CI, 0.81 to 1.37).Conclusions In adults undergoing mechanical ventilation in the ICU, the use of conservative oxygen therapy, as compared with usual oxygen therapy, did not significantly affect the number of ventilator-free days. (Funded by the Health Research Council of New Zealand; ICU-ROX Australian and New Zealand Clinical Trials Registry number, ACTRN12615000957594.)