Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy.
Crit Care. 2022 Oct 21;26(1):323. doi: 10.1186/s13054-022-04186-8.
Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO with patients' outcome.
Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO < 60 mmHg and severe hyperoxemia as PaO > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months.
1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003).
In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients.
clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
心脏骤停后复苏患者的最佳氧目标值尚不确定。本研究的主要目的是描述在院外心脏骤停（OHCA）患者机械通气的最初 72 小时内，部分氧分压（PaO）值以及低氧血症和高氧血症发作的数值。次要目的是评估 PaO 与患者预后的关系。
OHCA 后目标低温与目标常温治疗（TTM2）试验的预先计划的二次分析。在随机分组后每 4 小时采集动脉血气值，前 32 小时，然后每 8 小时采集一次，直到第 3 天。低氧血症定义为 PaO＜60mmHg，严重高氧血症定义为 PaO＞300mmHg。在 6 个月时收集死亡率和不良神经结局（根据改良 Rankin 量表定义）。
共纳入 1418 例患者。平均年龄为 64±14 岁，292 例（20.6%）为女性。24.9%的患者至少发生一次低氧血症，7.6%的患者至少发生一次严重高氧血症。低氧血症和高氧血症均与 6 个月死亡率独立相关，但与不良神经结局无关。与 6 个月死亡率相关的低氧血症最佳截断点为 69mmHg（风险比 RR=1.009，95%置信区间 0.93-1.09），高氧血症为 195mmHg（RR=1.006，95%置信区间 0.95-1.06）。高氧血症的时间暴露，即 PaO 曲线下面积（PaO-AUC）与死亡率显著相关（p=0.003）。
在 OHCA 患者中，低氧血症和高氧血症均与 6 个月死亡率相关，其作用由高氧值的时间暴露介导。在这组患者中应考虑精确调整氧水平。
clinicaltrials.gov NCT02908308，注册于 2016 年 9 月 20 日。
Zotero 插件
