Department of General Surgery, Suzhou Science & Technology Town Hospital, Suzhou, 215153, Jiangsu, People's Republic of China.
Department of Critical Care Medicine, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, Shantou, 515100, Guangdong, People's Republic of China.
Crit Care. 2022 Aug 5;26(1):239. doi: 10.1186/s13054-022-04114-w.
There is no consensus exists regarding the association between oxygen exposure (arterial oxygen tension or fraction of inspired oxygen) and outcomes for patients with mechanical ventilation. Additionally, whether the association remains persistent over time is unknown. We aimed to explore the association between exposure to different intensities of oxygen exposure over time and 28-day mortality in patients with mechanical ventilation.
We obtained data from the Medical Information Mart for Intensive Care IV (MIMIC-IV), which included adult (≥ 18 years) patients who received invasive mechanical ventilation for at least 48 h. We excluded patients who received extracorporeal membrane oxygenation (ECMO) or who initiated ventilation more than 24 h after ICU admission. The primary outcome was 28-day mortality. Piece-wise exponential additive mixed models were employed to estimate the strength of associations over time.
A total of 7784 patients were included in the final analysis. Patients had a median duration of invasive mechanical ventilation of 8.1 days (IQR: 3.8-28 days), and the overall 28-day mortality rate was 26.3%. After adjustment for baseline and time-dependent confounders, both daily time-weighted average (TWA) arterial oxygen tension (PaO) and fraction of inspired oxygen (FiO) were associated with increased 28-day mortality, and the strength of the association manifested predominantly in the early-middle course of illness. A significant increase in the hazard of death was found to be associated with daily exposure to TWA-PaO ≥ 120 mmHg (Hazard ratio 1.166, 95% CI 1.059-1.284) or TWA-FiO ≥ 0.5 (Hazard ratio 1.496, 95% CI 1.363-1.641) during the entire course. A cumulative effect of harmful exposure (TWA-PaO ≥ 120 mmHg or TWA-FiO ≥ 0.5) was also observed.
PaO and FiO should be carefully monitored in patients with mechanical ventilation, especially during the early-middle course after ICU admission. Cumulative exposure to higher intensities of oxygen exposure was associated with an increased risk of death.
目前，关于机械通气患者的氧暴露（动脉氧分压或吸入氧分数）与结局之间的关联尚未达成共识。此外，这种关联是否随着时间的推移仍然存在尚不清楚。我们旨在探讨机械通气患者随时间变化的不同氧暴露强度与 28 天死亡率之间的关联。
我们从 Medical Information Mart for Intensive Care IV（MIMIC-IV）中获取数据，该数据包括至少接受 48 小时有创机械通气的成年（≥18 岁）患者。我们排除了接受体外膜氧合（ECMO）或在 ICU 入院后 24 小时以上开始通气的患者。主要结局是 28 天死亡率。分段指数增长混合模型用于估计随时间变化的关联强度。
最终纳入 7784 例患者进行分析。患者有创机械通气的中位时间为 8.1 天（IQR：3.8-28 天），总体 28 天死亡率为 26.3%。调整基线和随时间变化的混杂因素后，每日时间加权平均（TWA）动脉氧分压（PaO）和吸入氧分数（FiO）均与 28 天死亡率增加相关，关联强度主要表现在疾病的中早期。与每日 TWA-PaO≥120mmHg（危险比 1.166，95%CI 1.059-1.284）或 TWA-FiO≥0.5（危险比 1.496，95%CI 1.363-1.641）的每日暴露相关的死亡风险显著增加。还观察到有害暴露（TWA-PaO≥120mmHg 或 TWA-FiO≥0.5）的累积效应。
机械通气患者应密切监测 PaO 和 FiO，尤其是在 ICU 入院后的中早期。累积暴露于更高强度的氧暴露与死亡风险增加相关。
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