トラウマ患者に対する早期のリストリクティブ対リベラル酸素: TRAUMOX2 ランダム化臨床試験
Tobias Arleth1, Josefine Baekgaard1, Volkert Siersma2
1Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark.
JAMA
|December 10, 2024
まとめ
リベラルな酸素戦略と比較して,成人のトラウマ患者における制限酸素戦略は,死亡や呼吸器の合併症を有意に減少させなかった. この発見は,現在の酸素投与プロトコルは,最適な患者の結果のために再評価する必要があることを示唆しています.
科学分野:
- 緊急 医療
- 集中治療 医療
- トラウマ 手術
背景:
- リベラルな酸素投与は重度のトラウマでは一般的ですが,有害な結果に関連しています.
- トラウマの蘇生に最適な酸素戦略を導き出すには 証拠が必要です
研究 の 目的:
- 大人のトラウマ患者における死亡および/または主要な呼吸器合併症の減少における制限対リベラル酸素戦略の有効性を比較する.
主な方法:
- 1979年の成人のトラウマ患者を対象とした多センターランダム化試験です.
- 患者は8時間の制限 (SpO2目標94%) またはリベラル酸素戦略を受けた.
- 主なアウトカムは30日以内の死亡および/または主要な呼吸器合併症の複合でした.
主要な成果:
- 制限性 (16. 1%) とリベラル (16. 7%) の酸素群の複合結果では有意な差異はなかった (OR,1. 01;P=94).
- 複合的な結果の個々の要素も有意な違いを示さなかった.
- 酸素制限群では,アテレクタシスがより少ない (27. 6% vs 34. 7%).
結論:
- 早期の酸素制限戦略は,成人のトラウマ患者の死亡や重度の呼吸器系の合併症を有意に減少させなかった.
- 発見は,病院前または初期の病院での現在のリベラルな酸素投与慣習からの変更を支持しません.
- 患者の生理学に基づいた微妙な酸素定位をさらに研究することができます.
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