软组织氧合与死亡风险（STORM）：危重病的早期标志物？

Soft tissue oxygenation and risk of mortality (STORM): an early marker of critical illness?

作者信息

Kidane Biniam, Chadi Sami A, Di Labio Anthony, Priestap Fran, Haddara Wael, Mele Tina, Murkin John M

机构信息

Western University, Schulich School of Medicine & Dentistry, General Surgery, London, Canada; London Health Sciences Centre, General Surgery, London, Canada; McMaster University, Clinical Epidemiology & Biostatistics, Hamilton, Canada.

Western University, Schulich School of Medicine & Dentistry, General Surgery, London, Canada; London Health Sciences Centre, General Surgery, London, Canada.

出版信息

J Crit Care. 2015 Apr;30(2):315-20. doi: 10.1016/j.jcrc.2014.11.004. Epub 2014 Nov 13.

DOI:10.1016/j.jcrc.2014.11.004

PMID:25434719

Abstract

PURPOSE

Tissue oxygen saturation (StO2) is a noninvasive measure that reflects changes in tissue perfusion. Rapid response teams (RRTs) assess sick inpatients to determine need for intensive care unit (ICU) admission. This determination is subjective based on parameters such as systolic blood pressure, heart rate, and pulse oximetry. Our objective was to determine if parameters readily available at RRT bedside assessment (vital signs and StO2) can predict ICU admission and inhospital mortality.

MATERIALS AND METHODS

All inpatients assessed by RRT at a tertiary Canadian hospital were consecutively sampled for 3 months. After clinical assessment, the RRT physician (blinded to StO2) made the ultimate ICU admission decision.

RESULTS

In 134 included patients, mean age was 65.5 ± 15.2 years, and 53% (n = 71) were males. There were 49 ICU admissions (36.6%) and 31 mortalities (23.1%). Two multivariable models significantly predicted ICU admission and inhospital mortality. The only independent predictor of ICU admission was pulse oximetry (adjusted odds ratio, 0.88; 95% confidence interval, 0.80-0.96; P = .007). Tissue oxygen saturation did not predict ICU admission but was the only independent predictor of mortality (adjusted odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P = .04).

CONCLUSIONS

Tissue oxygen saturation may identify critical illness in patients who would not traditionally meet ICU admission criteria and thus may identify patients who benefit from closer monitoring.

摘要

目的

组织氧饱和度（StO2）是一种反映组织灌注变化的非侵入性测量方法。快速反应小组（RRT）对患病住院患者进行评估，以确定是否需要入住重症监护病房（ICU）。这种判定基于诸如收缩压、心率和脉搏血氧饱和度等参数，具有主观性。我们的目的是确定在RRT床边评估时易于获得的参数（生命体征和StO2）是否能够预测ICU入住率和住院死亡率。

材料与方法

在一家加拿大三级医院，对所有由RRT评估的住院患者进行连续3个月的抽样。经过临床评估后，RRT医生（对StO2不知情）做出最终的ICU入住决定。

结果

在纳入的134例患者中，平均年龄为65.5±15.2岁，53%（n = 71）为男性。有49例患者入住ICU（36.6%），31例死亡（23.1%）。两个多变量模型显著预测了ICU入住率和住院死亡率。ICU入住的唯一独立预测因素是脉搏血氧饱和度（调整后的优势比为0.88；95%置信区间为0.80 - 0.96；P = 0.007）。组织氧饱和度不能预测ICU入住，但却是死亡率的唯一独立预测因素（调整后的优势比为1.06；95%置信区间为1.01 - 1.12；P = 0.04）。