Choi Won-Il, Shehu Esmeralda, Lim So Yeon, Koh Shin Ok, Jeon Kyeongman, Na Sungwon, Lim Chae-Man, Lee Young-Joo, Kim Seok Chan, Kim Ick Hee, Kim Je Hyeong, Kim Jae Yeol, Lim Jaemin, Rhee Chin Kook, Park Sunghoon, Kim Ho Cheol, Lee Jin Hwa, Lee Ji Hyun, Park Jisook, Koh Younsuck, Suh Gee Young
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea.
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea; Department of Internal Medicine, Regional Hospital of Durres, Albania.
J Crit Care. 2014 Oct;29(5):797-802. doi: 10.1016/j.jcrc.2014.05.017. Epub 2014 Jun 2.
This study described the acute hypoxemic respiratory failure (AHRF) population and identified potential modifiable markers of outcome.
A prospective, multicenter study was performed in 22 intensive care units (ICUs). The clinical outcomes of patients with acute respiratory distress syndrome (ARDS) were compared to the outcomes in patients with non-ARDS AHRF, and a propensity score matched analysis was performed.
A total 837 patients with an arterial oxygen tension/fraction of inspired oxygen ratio (Pao2/Fio2) less than 300 mm Hg on ICU admission were included. Of these, 163 patients met the criteria defining ARDS, whereas the remaining 674 patients who had unilateral or no pulmonary opacities were classified as non-ARDS AHRF. Baseline Pao2/Fio2 ratio, thrombocytopenia, increased positive end-expiratory pressure (PEEP) were significantly associated with the 60-day mortality in hypoxemic respiratory failure after multivariate analysis. However, ARDS was not associated with increased 60-day mortality when independent predictors for the 60-day mortality and propensity score were controlled. In the case-control study, the 60-day mortality rate was 38.6% in the ARDS group and 32.3% in the non-ARDS AHRF group. In both patients with ARDS and non-ARDS AHRF, the mortality rate increased proportionally to a lower baseline Pao2/Fio2.
Lower baseline oxygenation (Pao2/Fio2) is a poor prognostic marker in acute hypoxemic respiratory failure.
本研究描述了急性低氧性呼吸衰竭（AHRF）人群，并确定了可能影响预后的可调节指标。
在22个重症监护病房（ICU）进行了一项前瞻性多中心研究。将急性呼吸窘迫综合征（ARDS）患者的临床结局与非ARDS的AHRF患者的结局进行比较，并进行倾向评分匹配分析。
共纳入837例入住ICU时动脉血氧分压/吸入氧分数比（Pao2/Fio2）低于300 mmHg的患者。其中，163例患者符合ARDS的定义标准，其余674例单侧或无肺部浸润影的患者被归类为非ARDS的AHRF。多因素分析显示，基线Pao2/Fio2比值、血小板减少、呼气末正压（PEEP）升高与低氧性呼吸衰竭患者60天死亡率显著相关。然而，在控制了60天死亡率的独立预测因素和倾向评分后，ARDS与60天死亡率增加无关。在病例对照研究中，ARDS组60天死亡率为38.6%，非ARDS的AHRF组为32.3%。在ARDS和非ARDS的AHRF患者中，死亡率均与较低的基线Pao2/Fio2成比例增加。
较低的基线氧合水平（Pao2/Fio2）是急性低氧性呼吸衰竭预后不良的指标。
