在重症儿童中保守与自由的氧化目标 (Oxy-PICU):英国多中心,开放,并行组,随机临床试验
Mark J Peters1, Doug W Gould2, Samiran Ray3
1Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK; Respiratory, Critical Care and Anaesthesia Unit, Infection, Inflammation, and Immunity Division, University College London Great Ormond Street Institute of Child Health, London, UK; Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
与自由的目标相比,在重症儿童中,保守的氧化目标 (SpO2 88- 92%) 显著减少了器官支持的持续时间或死亡. 这一发现表明儿科重症监护室 (PICU) 的儿童的治疗结果有所改善.
科学领域:
- 儿童重症监护医疗
- 呼吸系统生理学
- 临床试验设计
背景情况:
- 在重症儿童中,最佳的全身氧化目标尚不清楚.
- 虽然自由氧化很常见,但对儿童患者可能会带来风险.
- 这项研究评估了保守的氧化与标准护理,以减少器官支持和死亡率.
研究的目的:
- 在侵袭性通风儿童中,将保守氧化 (SpO2 88-92%) 与自由氧化 (SpO2 > 94%) 进行比较.
- 要确定保守的方法是否会减少器官支持的持续时间或在30天内死亡的发生率.
- 在儿科重症监护室 (PICU) 评估不同氧化策略的安全性和有效性.
主要方法:
- 一个实用的多中心随机对照试验 (Oxy- PICU) 涉及英国15个PICU.
- 2040名接受侵袭性通风和补充氧气的儿童被随机 (1:1) 分给保守或自由的氧气目标.
- 主要结局是基于等级的器官支持续时间或30天后死亡,分析使用治疗意图.
主要成果:
- 保守的氧化目标显示出统计学上显著的结果改善 (概率指数为0.53, p=0.04).
- 与自由派组相比,保守派组的器官支持或死亡时间较短 (调整后的几率比率为0.84).
- 与自由主义者 (4%) 相比,保守派群体的不良事件略低 (3%).
结论:
- 保守的氧化目标 (SpO2 88- 92%) 显著改善了PICU中侵袭性通风儿童的结果.
- 这种策略更有可能减少器官支持的持续时间和死亡率.
- 广泛采用保守的氧气目标可以改善患者的治疗结果并降低医疗保健成本.
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