重症新型冠状病毒肺炎呼吸衰竭患者的全身氧利用：病例系列研究
Systemic Oxygen Utilization in Severe COVID-19 Respiratory Failure: A Case Series.
作者信息
Garg Rajeev K, Kimbrough Tara, Lodhi Wajahat, DaSilva Ivan
机构信息
Section of Critical Care Neurology, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States.
Department of Internal Medicine, University Parma Medical Center, Cleveland, Ohio, USA.
出版信息
Indian J Crit Care Med. 2021 Feb;25(2):215-218. doi: 10.5005/jp-journals-10071-23722.
BACKGROUND
Management of hypoxemia in patients with severe COVID-19 respiratory failure is based on the guideline recommendations for specific SpO targets. However, limited data exist on systemic O utilization. The objective of this study was to examine systemic O utilization in a case series of patients with this disease.
PATIENTS AND METHODS
Between March 24, and April 9, 2020, 8 patients intubated for severe COVID-19 respiratory failure had near-simultaneous drawing of arterial blood gas (ABG), central venous blood gas (cVBG), and central venous oxygen saturation (ScvO) at a mean of 6.1 days into hospitalization. Three patients were managed with indirect cardiac output (CO) monitoring by FloTrac sensor and Vigileo monitor (Edwards Lifesciences, Irvine, CA). The oxygen extraction index (OEI; SaO-ScvO/SaO) and oxygen extraction fraction (OEF; CaO-CvO/CaO ≥ 100) were calculated. Values for hyperoxia (ScvO ≥ 90%), normoxia (ScvO 71-89%), and hypoxia (ScvO ≤ 70%) were based on the literature. Mean values were calculated.
RESULTS
The mean partial pressure of oxygen (PaO) was 102 with a mean fraction of inspired O (FiO) of 44%. One patient was hyperoxic with a reduced OEI (17%). Five patients were normoxic, but 2 had a reduced OEF (mean 15.9%). Two patients were hypoxic but had increased systemic O utilization based on OEF or OEI.
CONCLUSION
In select patients with severe COVID-19 respiratory failure, O delivery (DO) was found to exceed O utilization. SpO targets based on systemic O utilization may help in reducing oxygen toxicity, especially in the absence of anaerobic metabolism. Further data are needed on the prevalence of systemic O utilization in COVID-19.
HOW TO CITE THIS ARTICLE
Garg RK, Kimbrough T, Lodhi W, DaSilva I. Systemic Oxygen Utilization in Severe COVID-19 Respiratory Failure: A Case Series. Indian J Crit Care Med 2021;25(2):215-218.
背景
重症新型冠状病毒肺炎（COVID-19）呼吸衰竭患者低氧血症的管理基于特定血氧饱和度（SpO）目标的指南建议。然而，关于全身氧利用的数据有限。本研究的目的是在一组该疾病患者中检查全身氧利用情况。
患者与方法
在2020年3月24日至4月9日期间，8例因重症COVID-19呼吸衰竭而插管的患者在住院平均6.1天时近乎同时采集动脉血气（ABG）、中心静脉血气（cVBG）和中心静脉血氧饱和度（ScvO）。3例患者通过FloTrac传感器和Vigileo监测仪（爱德华生命科学公司，加利福尼亚州欧文市）进行间接心输出量（CO）监测。计算氧摄取指数（OEI；SaO-ScvO/SaO）和氧摄取分数（OEF；CaO-CvO/CaO≥100）。高氧（ScvO≥90%）、正常氧（ScvO 71-89%）和低氧（ScvO≤70%）的值基于文献。计算平均值。
结果
平均氧分压（PaO）为102，平均吸入氧分数（FiO）为44%。1例患者为高氧血症，氧摄取指数降低（17%）。5例患者为正常氧血症，但2例氧摄取分数降低（平均15.9%）。2例患者为低氧血症，但基于氧摄取分数或氧摄取指数，其全身氧利用增加。
结论
在部分重症COVID-19呼吸衰竭患者中，发现氧输送（DO）超过氧利用。基于全身氧利用的SpO目标可能有助于降低氧中毒，尤其是在不存在无氧代谢的情况下。关于COVID-19中全身氧利用的患病率还需要更多数据。
如何引用本文
Garg RK, Kimbrough T, Lodhi W, DaSilva I. 重症COVID-19呼吸衰竭中的全身氧利用：病例系列。《印度重症监护医学杂志》2021；25(2):215-218。
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