Neurosciences Critical Care Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Neurosciences Critical Care Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Crit Care Med. 2021 Oct 1;49(10):e968-e977. doi: 10.1097/CCM.0000000000005069.
To evaluate the impact of duration of hyperoxia on neurologic outcome and mortality in patients undergoing venoarterial extracorporeal membrane oxygenation.
A retrospective analysis of venoarterial extracorporeal membrane oxygenation patients admitted to the Johns Hopkins Hospital. The primary outcome was neurologic function at discharge defined by modified Rankin Scale, with a score of 0-3 defined as a good neurologic outcome, and a score of 4-6 defined as a poor neurologic outcome. Multivariable logistic regression analysis was performed to evaluate the association between hyperoxia and neurologic outcomes.
The Johns Hopkins Hospital Cardiovascular ICU and Cardiac Critical Care Unit.
None.
We measured first and maximum Pao2 values, area under the curve per minute over the first 24 hours, and duration of mild, moderate, and severe hyperoxia. Of 132 patients on venoarterial extracorporeal membrane oxygenation, 127 (96.5%) were exposed to mild hyperoxia in the first 24 hours. Poor neurologic outcomes were observed in 105 patients (79.6%) (102 with vs 3 without hyperoxia; p = 0.14). Patients with poor neurologic outcomes had longer exposure to mild (19.1 vs 15.2 hr; p = 0.01), moderate (14.6 vs 9.2 hr; p = 0.003), and severe hyperoxia (9.1 vs 4.0 hr; p = 0.003). In a multivariable analysis, patients with worse neurologic outcome experienced longer durations of mild (adjusted odds ratio, 1.10; 95% CI, 1.01-1.19; p = 0.02), moderate (adjusted odds ratio, 1.12; 95% CI, 1.04-1.22; p = 0.002), and severe (adjusted odds ratio, 1.19; 95% CI, 1.06-1.35; p = 0.003) hyperoxia. Additionally, duration of severe hyperoxia was independently associated with inhospital mortality (adjusted odds ratio, 1.18; 95% CI, 1.08-1.29; p < 0.001).
In patients undergoing venoarterial extracorporeal membrane oxygenation, duration and severity of early hyperoxia were independently associated with poor neurologic outcomes at discharge and mortality.
评估接受动静脉体外膜肺氧合治疗的患者中，高氧暴露时间对神经功能结局和死亡率的影响。
对约翰霍普金斯医院收治的动静脉体外膜肺氧合患者进行回顾性分析。主要结局为改良Rankin 量表定义的出院时的神经功能，评分 0-3 定义为良好的神经功能结局，评分 4-6 定义为不良的神经功能结局。采用多变量逻辑回归分析评估高氧与神经结局之间的关联。
约翰霍普金斯医院心血管重症监护病房和心脏重症监护病房。
无。
我们测量了第 1 小时和最大 PaO2 值、第 1 至 24 小时内每分钟的曲线下面积、轻度、中度和重度高氧的持续时间。在 132 名接受动静脉体外膜肺氧合治疗的患者中，127 名（96.5%）在第 1 至 24 小时内出现轻度高氧。105 名患者（79.6%）出现不良神经结局（102 名有 vs 3 名无高氧；p = 0.14）。不良神经结局患者的轻度（19.1 小时 vs 15.2 小时；p = 0.01）、中度（14.6 小时 vs 9.2 小时；p = 0.003）和重度（9.1 小时 vs 4.0 小时；p = 0.003）高氧暴露时间更长。多变量分析显示，神经功能结局较差的患者经历了更长时间的轻度（校正优势比，1.10；95%可信区间，1.01-1.19；p = 0.02）、中度（校正优势比，1.12；95%可信区间，1.04-1.22；p = 0.002）和重度（校正优势比，1.19；95%可信区间，1.06-1.35；p = 0.003）高氧。此外，重度高氧持续时间与住院死亡率独立相关（校正优势比，1.18；95%可信区间，1.08-1.29；p < 0.001）。
在接受动静脉体外膜肺氧合治疗的患者中，早期高氧的持续时间和严重程度与出院时不良神经结局和死亡率独立相关。
