危重症患者最佳氧饱和度目标的探索：来自大型 ICU 数据库的观察性数据。

The Search for Optimal Oxygen Saturation Targets in Critically Ill Patients: Observational Data From Large ICU Databases.

机构信息

Yale-NUS College, National University Health System, National University of Singapore, Singapore.

School of Electrical Engineering, Nanyang Technological University.

出版信息

Chest. 2020 Mar;157(3):566-573. doi: 10.1016/j.chest.2019.09.015. Epub 2019 Oct 4.

DOI:10.1016/j.chest.2019.09.015

PMID:31589844

Abstract

BACKGROUND

Although low oxygen saturations are generally regarded as deleterious, recent studies in ICU patients have shown that a liberal oxygen strategy increases mortality. However, the optimal oxygen saturation target remains unclear. The goal of this study was to determine the optimal range by using real-world data.

METHODS

Replicate retrospective analyses were conducted of two electronic medical record databases: the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care III database (MIMIC). Only patients with at least 48 h of oxygen therapy were included. Nonlinear regression was used to analyze the association between median pulse oximetry-derived oxygen saturation (Spo) and hospital mortality. We derived an optimal range of Spo and analyzed the association between the percentage of time within the optimal range of Spo and hospital mortality. All models adjusted for age, BMI, sex, and Sequential Organ Failure Assessment score. Subgroup analyses included ICU types, main diagnosis, and comorbidities.

RESULTS

The analysis identified 26,723 patients from eICU-CRD and 8,564 patients from MIMIC. The optimal range of Spo was 94% to 98% in both databases. The percentage of time patients were within the optimal range of Spo was associated with decreased hospital mortality (OR of 80% vs 40% of the measurements within the optimal range, 0.42 [95% CI, 0.40-0.43] for eICU-CRD and 0.53 [95% CI, 0.50-0.55] for MIMIC). This association was consistent across subgroup analyses.

CONCLUSIONS

The optimal range of Spo was 94% to 98% and should inform future trials of oxygen therapy.

摘要

背景

尽管低氧饱和度通常被认为是有害的，但最近 ICU 患者的研究表明，宽松的氧疗策略会增加死亡率。然而，最佳的氧饱和度目标仍不清楚。本研究旨在使用真实世界的数据确定最佳范围。

方法

对两个电子病历数据库进行了重复的回顾性分析：eICU 协作研究数据库（eICU-CRD）和重症监护医疗信息集市 III 数据库（MIMIC）。仅纳入至少接受 48 小时氧疗的患者。使用非线性回归分析中位脉搏血氧仪衍生氧饱和度（Spo）与住院死亡率之间的关系。我们得出了 Spo 的最佳范围，并分析了 Spo 处于最佳范围内的时间百分比与住院死亡率之间的关系。所有模型均调整了年龄、BMI、性别和序贯器官衰竭评估评分。亚组分析包括 ICU 类型、主要诊断和合并症。

结果

分析从 eICU-CRD 中确定了 26723 例患者，从 MIMIC 中确定了 8564 例患者。两个数据库中 Spo 的最佳范围均为 94%~98%。患者处于 Spo 最佳范围内的时间百分比与住院死亡率降低相关（eICU-CRD 中测量值在最佳范围内的 80%与 40%相比，OR 为 0.42[95%CI，0.40-0.43]；MIMIC 中为 0.53[95%CI，0.50-0.55]）。这种关联在亚组分析中是一致的。