低正常与高正常氧化度对严重病患者器官功能障碍的影响:随机临床试验
Harry Gelissen1, Harm-Jan de Grooth1,2, Yvo Smulders3
1Department of Intensive Care Medicine, Research VUmc Intensive Care, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity Institute, Amsterdam Medical Data Science, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.
JAMA
|August 31, 2021
概括
与较高的正常度相比,针对较低的正常氧度 (Pao2) 的危急病患者没有显著减少器官功能障碍. 可能需要进一步的研究来证实这些发现.
科学领域:
- 危急护理医学
- 肺病学
- 肝脏病学
背景情况:
- 危急病患者的高氧化可能会恶化器官功能障碍.
- 系统性炎症反应综合征 (SIRS) 患者的最佳氧化目标仍未确定.
研究的目的:
- 为了比较低正常的Pao2目标与高正常的Pao2目标对SIRS重症患者的器官功能障碍的影响.
- 研究不同氧化目标对机械通风持续时间,住院死亡率和缺血事件的影响.
主要方法:
- 这是一项多中心随机临床试验,涉及4个重症监护病房的574名SIRS标准的成年患者.
- 患者被随机分配到一个低正常的Pao2目标 (8-12 kPa) 或高正常的Pao2目标 (14-18 kPa).
- 主要结局是SOFARANK,这是14天内的非呼吸器官衰竭的综合测量.
主要成果:
- 在低正常和高正常的Pao2组之间,SOFARANK评分没有统计学意义上的差异 (中位数差异,10分;P=.06).
- 在两组之间观察到类似的机械通风持续时间和住院死亡率.
- 在低正常Pao2组中,轻度低血测量更为频繁 (1.9%对1.2%).
结论:
- 与高正常目标相比,针对严重病患者的低正常Pao2并没有导致器官功能障碍的统计显著减少.
- 这项研究可能不足以检测较小的治疗效应.
- 需要进一步的研究,以确定这种患者群体的最佳氧化策略.
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