Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka 573-1191, Japan.
Biomed Res Int. 2021 Oct 14;2021:7332027. doi: 10.1155/2021/7332027. eCollection 2021.
Septic patients often require mechanical ventilation due to respiratory dysfunction, and effective ventilatory strategies can improve survival. The effects of the combination of permissive hypoxia and hyperoxia avoidance for managing mechanically ventilated patients are unknown. This study examines these effects on outcomes in mechanically ventilated septic patients.
In a retrospective before-and-after study, we examined adult septic patients (aged ≥18 years) requiring mechanical ventilation at a university hospital. On April 1, 2017, our mechanical ventilation policy changed from a conventional oxygenation target (SpO: ≥96%) to more conservative targets with permissive hypoxia (SpO: 88-92% or PaO: 60 mmHg) and hyperoxia avoidance (reduced oxygenation for PaO > 110 mmHg). Patients were divided into a prechange group (April 2015 to March 2017; = 83) and a postchange group (April 2017 to March 2019; = 130). Data were extracted from clinical records and insurance claims. Using a multiple logistic regression model, we examined the association of the postchange group (permissive hypoxia and hyperoxia avoidance) with intensive care unit (ICU) mortality after adjusting for variables such as Sequential Organ Failure Assessment (SOFA) score and PaO/FiO ratios.
The postchange group did not have significantly lower adjusted ICU mortality (0.67, 0.33-1.43; = 0.31) relative to the prechange group. However, there were significant intergroup differences in mechanical ventilation duration (prechange: 11.0 days, postchange: 7.0 days; = 0.01) and ICU stay (prechange: 11.0 days, postchange: 9.0 days; = 0.02).
Permissive hypoxia and hyperoxia avoidance had no significant association with reduced ICU mortality in mechanically ventilated septic patients. However, this approach was significantly associated with shorter mechanical ventilation duration and ICU stay, which can improve patient turnover and ventilator access.
由于呼吸功能障碍，败血症患者通常需要机械通气，有效的通气策略可以提高生存率。允许性低氧血症和避免高氧血症联合管理机械通气患者的效果尚不清楚。本研究探讨了这些效果对机械通气败血症患者结局的影响。
在一项回顾性前后对照研究中，我们检查了在一所大学医院需要机械通气的成年败血症患者（年龄≥18 岁）。2017 年 4 月 1 日，我们的机械通气策略从常规氧合目标（SpO₂：≥96%）改变为更保守的目标，允许性低氧血症（SpO₂：88-92%或 PaO：60mmHg）和避免高氧血症（当 PaO 超过 110mmHg 时减少氧合）。患者分为改变前组（2015 年 4 月至 2017 年 3 月；n=83）和改变后组（2017 年 4 月至 2019 年 3 月；n=130）。数据从临床记录和保险索赔中提取。使用多变量逻辑回归模型，在调整序贯器官衰竭评估（SOFA）评分和 PaO/FiO 比值等变量后，我们检查了改变后组（允许性低氧血症和避免高氧血症）与重症监护病房（ICU）死亡率的关联。
改变后组的 ICU 死亡率调整后无显著降低（0.67，0.33-1.43； = 0.31）。然而，两组间的机械通气时间（改变前：11.0 天，改变后：7.0 天； = 0.01）和 ICU 住院时间（改变前：11.0 天，改变后：9.0 天； = 0.02）存在显著差异。
允许性低氧血症和避免高氧血症与机械通气败血症患者 ICU 死亡率降低无显著关联。然而，这种方法与较短的机械通气时间和 ICU 住院时间显著相关，这可以改善患者周转率和呼吸机的使用。
