Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Copenhagen Centre for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2021 Aug;65(7):952-958. doi: 10.1111/aas.13810. Epub 2021 Mar 9.
Several studies in surgery and initial management of critical illness have indicated harmful effects of short-term exposure to hyperoxia. Exposure to and consequences of excessive oxygen administration in hospital wards are sparsely investigated. The aim of this study was to investigate the association between excessive oxygen administration in patients admitted to surgical or medical wards and 30-day mortality.
We included patients in the Capital Region of Denmark who were admitted to hospital in 2014 for either myocardial infarction, acute exacerbation of chronic obstructive pulmonary disease (COPD), hip fracture or open abdominal surgery. We defined groups of inadequate, adequate or excessive oxygen administration based on peripheral oxygen saturation and oxygen administration values in the first 48 hours after admission. The primary outcome was mortality within 30 days, and data were analysed with multivariable logistic regression for age, gender and comorbidities.
We retrieved data from 11 196 patients, of which 81% had adequate, 18% had excessive and 1.8% inadequate oxygen administration. Mortality at 30 days was 4.2%, 7.6% and 27%, respectively, OR 1.46 (95%CI 1.16-1.84), P = .001 for patients with excessive compared to adequate oxygen administration. The association was significant in subgroups of patients admitted for acute exacerbation of COPD (OR 1.67, 95%CI 1.19-2.34) and myocardial infarction (OR 3.50, 95%CI 1.55-7.89).
Patients who received excessive oxygen administration in surgical and medical wards during the first 48 hours of admission had a higher mortality risk within 30 days compared to patients with adequate oxygen administration. However, inadequate oxygen therapy still renders highest mortality and should be avoided.
几项外科和危重病初始管理研究表明，短期暴露于高氧环境会产生有害影响。目前对住院病房过度供氧的暴露和后果的研究甚少。本研究旨在调查外科或内科病房患者接受过度供氧与 30 天死亡率之间的关系。
我们纳入了 2014 年在丹麦首都大区因心肌梗死、慢性阻塞性肺疾病（COPD）急性加重、髋部骨折或开放性腹部手术而住院的患者。我们根据入院后 48 小时内外周血氧饱和度和供氧值将患者分为供氧不足、供氧适当和供氧过度三组。主要结局为 30 天内死亡率，采用多变量逻辑回归分析年龄、性别和合并症。
我们从 11196 名患者中提取了数据，其中 81%的患者供氧适当，18%的患者供氧过度，1.8%的患者供氧不足。30 天死亡率分别为 4.2%、7.6%和 27%，过度供氧组与适当供氧组相比，OR 值为 1.46（95%CI 1.16-1.84），P ＜ 0.001。在 COPD 急性加重（OR 1.67，95%CI 1.19-2.34）和心肌梗死（OR 3.50，95%CI 1.55-7.89）患者亚组中，该相关性具有统计学意义。
与供氧适当的患者相比，外科和内科病房患者在入院前 48 小时内接受过度供氧，30 天内的死亡率风险更高。然而，供氧不足仍会导致最高的死亡率，应避免这种情况。
