使用 SpO/FiO 预测 COVID-19 所致 ARDS 行有创机械通气 ICU 患者的预后 - PRoVENT-COVID 研究的新发现。
Prognostication using SpO/FiO in invasively ventilated ICU patients with ARDS due to COVID-19 - Insights from the PRoVENT-COVID study.
机构信息
Department of Intensive Care, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, Location 'AMC', Amsterdam, the Netherlands.
Department of Anesthesiology, Hospital Universitario la Fe, Valencia, Spain; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria Valencia, Spain.
出版信息
J Crit Care. 2022 Apr;68:31-37. doi: 10.1016/j.jcrc.2021.11.009. Epub 2021 Dec 3.
BACKGROUND
The SpO/FiO is a useful oxygenation parameter with prognostic capacity in patients with ARDS. We investigated the prognostic capacity of SpO/FiO for mortality in patients with ARDS due to COVID-19.
METHODS
This was a post-hoc analysis of a national multicenter cohort study in invasively ventilated patients with ARDS due to COVID-19. The primary endpoint was 28-day mortality.
RESULTS
In 869 invasively ventilated patients, 28-day mortality was 30.1%. The SpO/FiO on day 1 had no prognostic value. The SpO/FiO on day 2 and day 3 had prognostic capacity for death, with the best cut-offs being 179 and 199, respectively. Both SpO/FiO on day 2 (OR, 0.66 [95%-CI 0.46-0.96]) and on day 3 (OR, 0.70 [95%-CI 0.51-0.96]) were associated with 28-day mortality in a model corrected for age, pH, lactate levels and kidney dysfunction (AUROC 0.78 [0.76-0.79]). The measured PaO/FiO and the PaO/FiO calculated from SpO/FiO were strongly correlated (Spearman's r = 0.79).
CONCLUSIONS
In this cohort of patients with ARDS due to COVID-19, the SpO/FiO on day 2 and day 3 are independently associated with and have prognostic capacity for 28-day mortality. The SpO/FiO is a useful metric for risk stratification in invasively ventilated COVID-19 patients.
背景
SpO/FiO 是一种有用的氧合参数，具有 ARDS 患者的预后能力。我们研究了 SpO/FiO 对 COVID-19 所致 ARDS 患者死亡率的预后能力。
方法
这是一项全国多中心队列研究的事后分析，该研究纳入了因 COVID-19 而接受有创通气的 ARDS 患者。主要终点为 28 天死亡率。
结果
在 869 例接受有创通气的患者中，28 天死亡率为 30.1%。第 1 天的 SpO/FiO 没有预后价值。第 2 天和第 3 天的 SpO/FiO 对死亡具有预后能力，最佳截断值分别为 179 和 199。第 2 天（OR，0.66 [95%-CI 0.46-0.96]）和第 3 天（OR，0.70 [95%-CI 0.51-0.96]）的 SpO/FiO 与校正年龄、pH 值、乳酸水平和肾功能不全的模型中的 28 天死亡率相关（AUROC 0.78 [0.76-0.79]）。实测 PaO/FiO 和 SpO/FiO 计算得出的 PaO/FiO 之间具有很强的相关性（Spearman's r = 0.79）。
结论
在本项由 COVID-19 引起的 ARDS 患者队列研究中，第 2 天和第 3 天的 SpO/FiO 与 28 天死亡率独立相关，具有预后能力。SpO/FiO 是对接受有创通气的 COVID-19 患者进行风险分层的有用指标。
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