異常以上の酸素圧力と,心停止後の蘇生後の結果との関連
J Hope Kilgannon1, Alan E Jones, Joseph E Parrillo
1Department of Emergency Medicine, Cooper University Hospital, Camden, NJ 08103, USA.
Circulation
|May 25, 2011
まとめ
心停止後の高酸素レベルは,投与量に依存した方法で死亡リスクを増加させます. この研究では,特定の有害な酸素の値が見つかりませんでしたが,蘇生後の注意深い酸素管理を強調しています.
科学分野:
- クリティカルケア・メディシン
- 心臓病学 心臓病学
- 肺内医学は肺内医学である.
背景:
- 新興の証拠は,心停止の蘇生後の高酸素症が有害であることを示唆しています.
- 酸素濃度の上昇と有害な結果の間の正確な関係は不明であり,値効果と用量依存の関連性に関する議論が続いている.
研究 の 目的:
- 動脈酸素 (PaO2) の超正常部分圧力と,蘇生後の患者の入院死亡率との関連を調査する.
- 過剰酸素血症による有害な結果が,値効果または用量依存のパターンに従うかどうかを判断する.
主な方法:
- 120の米国の病院からのプロジェクトIMPACTデータベースを利用したマルチセンターコホート研究.
- 集中治療室に入院する前に心肺蘇生を受けた成人,非トラウマ患者,および蘇生後の血液ガス分析を受けた.
- ICU入院後24時間以内に最も高いPaO2で定義された曝露; 主なアウトカムは入院死亡率でした.
主要な成果:
- 合計4459人の患者が分析され,入院死亡率は54%でした.
- 平均PaO2は231mmHg (IQR149-349) でした.
- PaO2の増加は,死亡率の増加と生存率の低下を伴う線形的な傾向を示した. PaO2の100mmHg増加は,死亡リスクの24%の増加と相関していた (OR 1.24,95%CI 1.18-1.31).
結論:
- 投与量に依存した有意な関連性は,超正常な酸素圧力と,蘇生後の患者の入院死亡率の間に存在する.
- 害の特定の値を支持する証拠はなく,より高い酸素レベルは一貫して死亡リスクを増加させた.
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