重症监护室中较低或较高的氧化目标:对个体患者数据的元分析
Frederik Mølgaard Nielsen1, Thomas L Klitgaard2, Niels Henrik Bruun3
1Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Hobrovej 18-21, 9000, Aalborg, Denmark. frederik.nielsen@rn.dk.
Intensive care medicine
|July 11, 2024
概括
针对重症监护室 (ICU) 患者的动脉氧气 (PaO2) 部分压力为8-12kPa,死亡率或没有生命支持的生存日数没有显著差异. 亚组分析显示,在特定的患者群体中,潜在的益处.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 临床试验 临床试验
背景情况:
- 对于ICU中急性缺血性呼吸衰竭的最佳氧化目标仍然没有定义.
- 以前的试验显示出显著的设计变异性,使元分析复杂化.
研究的目的:
- 为了比较针对成人ICU患者的8-12kPa的动脉氧气 (PaO2) 部分压力.
- 通过对HOT-ICU和HOT-COVID试验的元分析,评估不同氧化目标的益处和危害.
主要方法:
- 对HOT-ICU和HOT-COVID试验的个体患者数据进行元分析.
- 评估90天全因死亡率和没有生命支持的活日.
- 使用ICEMAN仪器在14个子组中评估治疗效应 (HTE) 的异质性.
主要成果:
- 在8kPa (40.4%) 和12kPa (40.9%) 组之间90天死亡率没有显著差异 (RR 0.99;95% CI 0.92-1.07).
- 在没有生命支持的情况下活着的日子中没有观察到任何差异.
- 亚组分析表明,COVID-19患者具有8kPa目标和癌症患者具有12kPa目标 (可信度不同) 的潜在益处.
结论:
- 在ICU患者中比较PaO2目标8-12kPa时,死亡率或没有生命支持的活日没有整体差异.
- 在COVID-19和癌症患者小组中建议治疗效应 (HTE) 的异质性.
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