Gomes E P, Reboredo M M, Costa G B, Barros F S, Carvalho E V, Pinheiro B V
Pulmonary and Critical Care Division, University Hospital of Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.
School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
Med Intensiva. 2023 Apr;47(4):212-220. doi: 10.1016/j.medin.2022.04.004. Epub 2022 May 2.
We examined weather a protocol for fraction of inspired oxygen (FiO) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated.
Prospective cohort study.
Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil.
Consecutive patients with COVID-19 mechanically ventilated.
One ICU followed a FiO adjustment protocol based on SpO (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU.
Prevalence of hyperoxemia (PaO >100 mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO > 0.6 in patients with hyperoxemia) were compared between the two ICUs.
Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, < 0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, < 0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, < 0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO use and adverse clinical outcomes.
Following FiO protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic.
我们研究了一种调整吸入氧分数（FiO）的方案是否能减少机械通气的COVID-19患者的高氧血症和过度吸氧情况。
前瞻性队列研究。
巴西两个专门收治COVID-19患者的重症监护病房（ICU）。
连续的机械通气COVID-19患者。
一个ICU遵循基于血氧饱和度（SpO）的FiO调整方案（保守氧疗ICU），另一个未遵循该方案的ICU作为对照ICU。
比较两个ICU在第1天高氧血症（动脉血氧分压[PaO₂]>100 mmHg）的发生率、持续性高氧血症（第1天和第2天均存在）以及过度吸氧情况（高氧血症患者FiO₂>0.6）。
保守氧疗ICU纳入82例患者，对照ICU纳入145例患者。保守氧疗ICU在第1天高氧血症的发生率较低（40.2%对75.9%，P<0.001），持续性高氧血症的发生率也较低（12.2%对49.6%，P<0.001）。第1天保守氧疗ICU过度吸氧的情况较少（18.3%对52.4%，P<0.001）。入住对照ICU与高氧血症和过度吸氧独立相关。多变量分析发现第1天高氧血症、持续性高氧血症或FiO₂过度使用与不良临床结局之间无独立关系。
遵循FiO方案与较低的高氧血症发生率和较少的过度吸氧情况相关。尽管这些结果与更好的临床结局无关，但在COVID-19大流行期间出现的氧气资源匮乏的情况下，采用FiO方案可能是有用的。
