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.
Pulmonary and Critical Care Division, University Hospital of Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.
Med Intensiva (Engl Ed). 2023 Apr;47(4):212-220. doi: 10.1016/j.medine.2022.04.020. Epub 2022 Nov 4.
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>100mmHg) 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%, p<0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p<0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p<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.
我们研究了调整吸入氧分数（FiO）的方案是否可以减少 COVID-19 患者机械通气时的高氧血症和过度吸氧。
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 COVID-19 机械通气患者。
一个 ICU 遵循基于 SpO 的 FiO 调整方案（保守吸氧 ICU），另一个 ICU 不遵循方案，作为对照组。
比较两组患者第 1 天高氧血症（PaO>100mmHg）的发生率、持续高氧血症（第 1 天和第 2 天存在）和过度吸氧（高氧血症患者 FiO>0.6）。
保守吸氧 ICU 组纳入 82 例患者，对照组纳入 145 例患者。保守吸氧 ICU 第 1 天高氧血症的发生率较低（40.2% vs. 75.9%，p<0.001），持续高氧血症的发生率也较低（12.2% vs. 49.6%，p<0.001）。保守吸氧 ICU 第 1 天过度吸氧的情况也较少（18.3% vs. 52.4%，p<0.001）。入住对照组 ICU 与高氧血症和过度吸氧有关。多变量分析发现第 1 天高氧血症、持续高氧血症或过度 FiO 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和较少的过度吸氧有关。尽管这些结果与更好的临床结局无关，但在 COVID-19 大流行期间氧气资源匮乏的情况下，采用 FiO 方案可能是有用的。
