Emergency Department, Ng Teng Fong General Hospital.
Clinical Research Unit, Ng Teng Fong General Hospital.
Eur J Emerg Med. 2020 Apr;27(2):99-104. doi: 10.1097/MEJ.0000000000000634.
We investigated the effects of hyperoxemia on morbidity and mortality in acute cardiogenic pulmonary edema (ACPE).
We conducted a retrospective cohort study of patients in our emergency department (ED) with ACPE who received arterial blood gases. Patients were classified based on the first PaO2 as hypoxemic (<75 mmHg), normoxemic (75-100 mmHg) and hyperoxemic (>100 mmHg). The primary outcome was the rates of mechanical ventilation (MV). We also reported adjusted odds ratios (AOR) and their 95% confidence intervals (CI) of the primary outcome after adjusting for predictors of MV determined a priori. Secondary outcomes were median hospital length of stay (LOS) and in-hospital mortality.
We recruited 335 patients; 34.0% had hyperoxemia. The rates of normoxemia and hypoxemia were 27.5% and 38.5%, respectively. The rates of MV were: hypoxemic 60/129 (46.5%) vs. normoxemic 41/92 (44.6%) vs. hyperoxemic 50/114 (43.9%); P = 0.62. The AORs for MV for the hyperoxemic and hypoxemic groups (reference: normoxemic group) were 0.98 (95% CI: 0.53-1.79) and 1.38 (95% CI: 0.77-2.48), respectively. Intubation rates for the groups were: hypoxemic 15/129 (11.6%) vs. normoxemic 6/92 (6.5%) vs. hyperoxemic 12/114 (10.6%); P = 0.43. The secondary outcomes were comparable among the groups. In-hospital mortality rates were: hypoxemic 6/129 (4.7%) vs. 6/92 (6.5%) vs. 10/114 (8.8%); P = 0.42.
Our exploratory study did not report effects on mechanical ventilation, median hospital LOS and in-hospital mortality from hyperoxemia compared to hypoxemic and normoxemic ED patients with ACPE. Further studies are warranted to prove or disprove our findings.
我们研究了高氧血症对急性心源性肺水肿（ACPE）患者发病率和死亡率的影响。
我们对在急诊部（ED）接受动脉血气检查的 ACPE 患者进行了回顾性队列研究。患者根据首次 PaO2 分为低氧血症（<75mmHg）、氧合正常（75-100mmHg）和高氧血症（>100mmHg）。主要结局是机械通气（MV）的发生率。我们还报告了调整了机械通气预测因素后的主要结局的调整比值比（AOR）及其 95%置信区间（CI）。次要结局是中位住院时间（LOS）和院内死亡率。
我们共招募了 335 名患者，其中 34.0%存在高氧血症。氧合正常和低氧血症的发生率分别为 27.5%和 38.5%。MV 的发生率为：低氧血症 60/129（46.5%）与氧合正常 41/92（44.6%）与高氧血症 50/114（43.9%）；P=0.62。高氧血症和低氧血症组的 MV 的 AOR（参考：氧合正常组）分别为 0.98（95%CI：0.53-1.79）和 1.38（95%CI：0.77-2.48）。各组的插管率为：低氧血症 15/129（11.6%）与氧合正常 6/92（6.5%）与高氧血症 12/114（10.6%）；P=0.43。次要结局在各组之间相似。院内死亡率为：低氧血症 6/129（4.7%）与氧合正常 6/92（6.5%）与高氧血症 10/114（8.8%）；P=0.42。
与低氧血症和氧合正常的 ED 急性心源性肺水肿患者相比，我们的探索性研究未报告高氧血症对机械通气、中位住院 LOS 和院内死亡率的影响。需要进一步的研究来证实或反驳我们的发现。
