Cai Guolong, Ru Weizhe, Xu Qianghong, Wu Jiong, Gong Shijin, Yan Jing, Shen Yanfei
Department of Intensive Care, Zhejiang Hospital, Hangzhou, China.
Department of Oncology, Cixi People's Hospital, Cixi, China.
Front Med (Lausanne). 2021 Sep 9;8:681200. doi: 10.3389/fmed.2021.681200. eCollection 2021.
Arterial hyperoxia is reportedly a risk factor for poor outcomes in patients with hemorrhagic brain injury (HBI). However, most previous studies have only evaluated the effects of hyperoxia using static oxygen partial pressure (PaO) values. This study aimed to investigate the association between overall dynamic oxygenation status and HBI outcomes, using longitudinal PaO data. Data were extracted from the Medical Information Mart for Intensive Care III database. Longitudinal PaO data obtained within 72 h of admission to an intensive care unit were analyzed, using a group-based trajectory approach. In-hospital mortality was used as the primary outcomes. Multivariable logistic models were used to explore the association between PaO trajectory and outcomes. Data of 2,028 patients with HBI were analyzed. Three PaO trajectory types were identified: Traj-1 (mild hyperoxia), Traj-2 (transient severe hyperoxia), and Traj-3 (persistent severe hyperoxia). The initial and maximum PaO of patients with Traj-2 and Traj-3 were similar and significantly higher than those of patients with Traj-1. However, PaO in patients with Traj-2 decreased more rapidly than in patients with Traj-3. The crude in-hospital mortality was the lowest for patients with Traj-1 and highest for patients with Traj-3 (365/1,303, 209/640, and 43/85 for Traj-1, Traj-2, and Traj-3, respectively; < 0.001), and the mean Glasgow Coma Scale score at discharge (GCS) was highest for patients with Traj-1 and lowest in patients with Traj-3 (13 [7-15], 11 [6-15], and 7 [3-14] for Traj-1, Traj-2, and Traj-3, respectively; < 0.001). The multivariable model revealed that the risk of death was higher in patients with Traj-3 than in patients with Traj-1 (odds ratio [OR]: 3.3, 95% confidence interval [CI]: 1.9-5.8) but similar for patients with Traj-1 and Traj-2. Similarly, the logistic analysis indicated the worst neurological outcomes in patients with Traj-3 (OR: 3.6, 95% CI: 2.0-6.4, relative to Traj-1), but similar neurological outcomes for patients in Traj-1 and Traj-2. Persistent, but not transient severe arterial hyperoxia, was associated with poor outcome in patients with HBI.
据报道，动脉血氧过高是出血性脑损伤（HBI）患者预后不良的一个危险因素。然而，大多数先前的研究仅使用静态氧分压（PaO）值评估了高氧的影响。本研究旨在利用纵向PaO数据调查整体动态氧合状态与HBI预后之间的关联。数据从重症监护医学信息数据库III中提取。采用基于组的轨迹方法分析了重症监护病房入院72小时内获得的纵向PaO数据。住院死亡率作为主要结局。使用多变量逻辑模型探讨PaO轨迹与结局之间的关联。对2028例HBI患者的数据进行了分析。确定了三种PaO轨迹类型：轨迹1（轻度高氧）、轨迹2（短暂性重度高氧）和轨迹3（持续性重度高氧）。轨迹2和轨迹3患者的初始和最高PaO相似，且显著高于轨迹1患者。然而，轨迹2患者的PaO下降速度比轨迹3患者更快。轨迹1患者的粗住院死亡率最低，轨迹3患者最高（轨迹1、轨迹2和轨迹3分别为365/1303、209/640和43/85；<0.001），出院时的平均格拉斯哥昏迷量表评分（GCS）轨迹1患者最高，轨迹3患者最低（轨迹1、轨迹2和轨迹3分别为13[7-15]、11[6-15]和7[3-14]；<0.001）。多变量模型显示，轨迹3患者的死亡风险高于轨迹1患者（比值比[OR]：3.3，95%置信区间[CI]：1.9-5.8），但轨迹1和轨迹2患者相似。同样，逻辑分析表明轨迹3患者的神经功能结局最差（OR：3.6，95%CI：2.0-6.4，相对于轨迹1），但轨迹1和轨迹2患者的神经功能结局相似。持续性而非短暂性重度动脉血氧过高与HBI患者的不良结局相关。
