From the Divisions of Allergy, Pulmonary, and Critical Care Medicine (M.W.S., J.D.C., M.A.H., E.T.Q., K.P.S., G.R.B., T.W.R.) and Respiratory Care (B.D.L., P.G.H.), the Departments of Pharmaceutical Services (J.L.S.), Medicine (K.G.B., J.H.B.), Biostatistics (L.W., C.J.L.), Anesthesiology (R.E.F., J.P.W.), Biomedical Informatics (R.E.F., J.P.W.), and Emergency Medicine (J.H.H., W.H.S.), and the Vanderbilt Institute for Clinical and Translational Research (G.R.B., W.H.S., T.W.R.), Vanderbilt University Medical Center, and the Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System (J.H.H.) - all in Nashville.
N Engl J Med. 2022 Nov 10;387(19):1759-1769. doi: 10.1056/NEJMoa2208415. Epub 2022 Oct 24.
Invasive mechanical ventilation in critically ill adults involves adjusting the fraction of inspired oxygen to maintain arterial oxygen saturation. The oxygen-saturation target that will optimize clinical outcomes in this patient population remains unknown.
In a pragmatic, cluster-randomized, cluster-crossover trial conducted in the emergency department and medical intensive care unit at an academic center, we assigned adults who were receiving mechanical ventilation to a lower target for oxygen saturation as measured by pulse oximetry (Spo) (90%; goal range, 88 to 92%), an intermediate target (94%; goal range, 92 to 96%), or a higher target (98%; goal range, 96 to 100%). The primary outcome was the number of days alive and free of mechanical ventilation (ventilator-free days) through day 28. The secondary outcome was death by day 28, with data censored at hospital discharge.
A total of 2541 patients were included in the primary analysis. The median number of ventilator-free days was 20 (interquartile range, 0 to 25) in the lower-target group, 21 (interquartile range, 0 to 25) in the intermediate-target group, and 21 (interquartile range, 0 to 26) in the higher-target group (P = 0.81). In-hospital death by day 28 occurred in 281 of the 808 patients (34.8%) in the lower-target group, 292 of the 859 patients (34.0%) in the intermediate-target group, and 290 of the 874 patients (33.2%) in the higher-target group. The incidences of cardiac arrest, arrhythmia, myocardial infarction, stroke, and pneumothorax were similar in the three groups.
Among critically ill adults receiving invasive mechanical ventilation, the number of ventilator-free days did not differ among groups in which a lower, intermediate, or higher Spo target was used. (Supported by the National Heart, Lung, and Blood Institute and others; PILOT ClinicalTrials.gov number, NCT03537937.).
在危重症成人接受有创机械通气时，需要调整吸入氧分数以维持动脉血氧饱和度。但目前仍不清楚该患者人群中哪种氧饱和度目标能优化临床结局。
在一项位于学术中心急诊和重症监护病房进行的实用、集群随机、集群交叉试验中，我们将接受机械通气的成人分为脉搏血氧饱和度（SpO2）测量值较低目标组（90%；目标范围 88 至 92%）、中间目标组（94%；目标范围 92 至 96%）或较高目标组（98%；目标范围 96 至 100%）。主要结局是通过第 28 天的存活且无机械通气天数（无呼吸机天数）。次要结局是第 28 天的死亡，数据截止到出院。
共有 2541 例患者纳入主要分析。较低目标组的无呼吸机天数中位数为 20 天（四分位距，0 至 25 天），中间目标组为 21 天（四分位距，0 至 25 天），较高目标组为 21 天（四分位距，0 至 26 天）（P=0.81）。较低目标组第 28 天院内死亡 281 例（34.8%），中间目标组 292 例（34.0%），较高目标组 290 例（33.2%）。三组的心脏骤停、心律失常、心肌梗死、卒中和气胸发生率相似。
在接受有创机械通气的危重症成人中，较低、中间或较高 SpO2 目标组的无呼吸机天数无差异。（由美国国立心肺血液研究所等资助；PILOT 临床试验.gov 编号，NCT03537937。）
