在静脉外体膜氧化患者中,保守或自由的氧气目标
Aidan Burrell1,2, Michael J Bailey1, Rinaldo Bellomo1,3,4
1Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Intensive care medicine
|August 20, 2024
概括
对静脉外体膜氧化 (VA-ECMO) 患者的保守氧气策略没有显著改变重症监护室 (ICU) 免费日. 这项研究比较了VA-ECMO患者中保守的 (92-96%SaO2) 与自由的 (97-100%SaO2) 氧气目标.
科学领域:
- 关键护理医学 关键护理医学
- 支持心血管系统的支持
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 在静脉外体膜氧化 (VA-ECMO) 治疗的患者经常经历动脉高氧化症,这是一种潜在的有害状况.
- 相反,过于严格的氧和目标可能会增加缺氧的风险,这是另一个不利的结果.
研究的目的:
- 在接受VA-ECMO的成年患者中,将保守的氧和目标 (92-96%) 与自由的目标 (97-100%) 的疗效进行比较.
- 确定不同氧气策略对无ICU日和其他临床结果的影响.
主要方法:
- 一项涉及300名VA-ECMO成年患者的多中心试验,随机分配给保守或自由的氧气策略.
- 通过呼吸机和ECMO气体混合器控制氧气的使用.
- 主要结局是28天内无ICU日数;次要结局包括死亡率和支持持续时间.
主要成果:
- 在保守 (0天) 和自由 (0天) 组之间,在28日无ICU日的中位数没有显著差异.
- 在28日和60日的死亡率,ECMO和通风持续时间以及停留时间在两组之间都相似.
- 与自由主义者群体 (1.3%) 相比,保守派群体的重大协议偏差率 (29.5%) 显著更高.
结论:
- 在VA-ECMO支持的成年ICU患者中,保守的氧气策略与自由的氧气策略相比,没有改善ICU无氧日.
- 这些发现表明,VA-ECMO目前的氧和目标可能需要重新评估,考虑到自由派群体的类似结果和更高的协议遵守.
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