Early Titration of Oxygen During Mechanical Ventilation Reduces Hyperoxemia in a Pilot, Feasibility, Randomized Control Trial for Automated Titration of Oxygen Levels.
Early Titration of Oxygen During Mechanical Ventilation Reduces Hyperoxemia in a Pilot, Feasibility, Randomized Control Trial for Automated Titration of Oxygen Levels.
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DOI：
10.1097/cce.0000000000000704
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发表时间：
2022-06
影响因子：
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通讯作者：
Diaz, Philip
中科院分区：
文献类型：
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作者：
Pannu, Sonal R.;Exline, Matthew;Klamer, Brett;Brock, Guy;Crouser, Elliott D.;Christman, John W.;Diaz, Philip
及时调节氧（FiO 2）对于预防高氧血症或发作性低氧血症至关重要。暴露于过量的Fio 2通常在机械通气开始后早期发现。在这项试点研究中，我们检查了临床试验的可行性，安全性和有效性，以优先考虑Fio 2滴定，并向呼吸治疗师发出电子警报。开放标签、随机对照初探性试验。重症监护室需要机械通气的成人。在开始机械通气后1小时开始方案氧滴定。当Spo 2超过92%而Fio 2 ≥ 0.5时，每隔30分钟触发一次呼吸治疗师电子警报。在对照组中，呼吸治疗师根据标准医嘱滴定Fio 2。主要终点是确定基于自动警报的早期Fio 2滴定在减少高血氧血症方面是否可行。次要分析包括警报的数量和频率、机械通气持续时间和ICU住院时间。在135名随机患者中，72名被分配到干预组，63名被分配到对照组，共发送了877个警报。干预组的高氧血症暴露显著减少，中位数为7.5小时（13.7 [四分位距（IQR），2.9-31.1] vs 21.2 [IQR，10.9-64.4]; p < 0.0004）。第一四分位数期间的最大FiO 2滴定导致机械通气时间和ICU停留时间显著减少。轻微低氧血症事件（Spo 2 < 88%）占警报的12%，9%为一过性，对单次Fio 2升高有反应，而3%的警报与复发性一过性低氧血症相关。我们的初步研究表明，由自动警报驱动的早期Fio 2滴定在ICU中是可行的，这反映在高氧血症暴露的统计学显著减少、有限的继发性低氧血症和ICU资源利用减少。这项试点研究的令人鼓舞的结果需要在更大的ICU队列中进行验证。
Timely regulation of oxygen (Fio2) is essential to prevent hyperoxemia or episodic hypoxemia. Exposure to excessive Fio2 is often noted early after onset of mechanical ventilation. In this pilot study, we examined the feasibility, safety, and efficacy of a clinical trial to prioritize Fio2 titration with electronic alerts to respiratory therapists. Open-labeled, randomized control pilot trial. Medical ICU. Adults requiring mechanical ventilation. Protocolized oxygen titration was initiated one hour after initiation of mechanical ventilation. When Spo2 exceeded 92% while on Fio2 ≥ 0.5, an electronic alert to respiratory therapists was triggered at 30-minute intervals. In the control arm, respiratory therapists titrated Fio2 by standard physician’s orders. The primary end point was to determine if early Fio2 titration based on automated alerts was feasible in terms of reducing hyperoxemia. Secondary analyses included the number and frequency of alerts, mechanical ventilation duration, and ICU length of stay. Among 135 randomized patients, 72 were assigned to the intervention arm and 63 to the control arm. A total 877 alerts were sent. Exposure to hyperoxemia was significantly reduced in the intervention group by a median of 7.5 hours (13.7 [interquartile range (IQR), 2.9–31.1] vs 21.2 [IQR, 10.9–64.4]; p < 0.0004). Maximal Fio2 titration during the first quartile resulted in significant reduction in mechanical ventilation duration and ICU stay. Minor hypoxemic events (Spo2 < 88%) represented 12% of alerts, 9% were transient and responded to a single Fio2 increase, whereas 3% of alerts were associated with recurrent transient hypoxemia. Our pilot study indicates that early Fio2 titration driven by automated alerts is feasible in the ICU, as reflected by a statistically significant reduction of hyperoxemia exposure, limited consequential hypoxemia, and reduced ICU resource utilization. The encouraging results of this pilot study need to be validated in a larger ICU cohort.