機械的に換気する重症成人患者における保守的な酸素療法:UK-ROXランダム化臨床試験
Daniel S Martin1,2, Doug W Gould3, Tasnin Shahid3
1Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom.
JAMA
|June 12, 2025
まとめ
ICUでの保守的な酸素治療は,機械呼吸器を施した患者の90日間の死亡率を有意に低下させなかった. 90%の周辺酸素飽和度 (SpO2) を目標としたこのアプローチは,死亡率を減らすために通常のケアよりも利益を示さなかった.
科学分野:
- クリティカル ケア 医療
- 呼吸器療法
- 臨床試験
背景:
- 補充酸素はICUでの一般的な介入ですが,最適な使用の証拠は限られています.
- 酸素の不足と過剰投与の両方から潜在的な害が存在します.
- 最も安全で有効な酸素供給目標の決定は 患者のアウトカムにとって極めて重要です
研究 の 目的:
- 保守的な酸素療法戦略が機械呼吸器のICU患者の90日間の死亡率を減少させるかどうかを評価する.
- 保守的なアプローチ (SpO2目標90%) と通常の酸素療法との間の死亡率を比較する.
主な方法:
- イギリスのICUで機械呼吸器を施した成人の患者16,500人を対象とした多センターで実践的なランダム化臨床試験です.
- 参加者は,保守的な酸素療法 (SpO2の最低FiO2は90%) または通常の酸素療法 (臨床医の判断) にランダムに割り当てられました.
- 主なアウトカムは90日後の全原因死亡率であり,次要アウトカムは入院およびICUの滞在期間および臓器のサポート期間でした.
主要な成果:
- 保守的な (35. 4%) と通常の (34. 9%) 酸素療法群の間で,すべての原因による90日間の死亡率において有意な差は認められなかった (リスク差は0. 7%,P=0. 28).
- 酸素への曝露は保守的なグループで29%低かった.
- ICU/入院と臓器のサポートのない日を含む二次的なアウトカムも,グループ間の有意な違いを示さなかった.
結論:
- 保守的な酸素療法による酸素曝露を最小限に抑えることは,機械呼吸器のICU患者における90日間の死亡率を有意に低下させなかった.
- 発見は,この集団の酸素管理のための現在の慣行は,この保守的な戦略に基づいて変更を必要としないかもしれないことを示唆しています.
- 保守的な酸素管理から恩恵を受ける特定の患者のサブグループを特定するために,さらなる研究が必要になる可能性があります.
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