丹麦奥尔堡大学医院Bodil S. Rasmussen团队比较了较低的氧合目标与较高目标对急性低氧性呼吸衰竭患者预后的影响。2021年1月20日，该研究发表在《新英格兰医学杂志》上。

重症监护病房（ICU）的急性低氧性呼吸衰竭患者采用补氧治疗，但不同氧合目标的利弊尚不清楚。研究组假设使用较低的动脉氧分压（PaO₂）目标比使用较高的目标会导致较低的死亡率。

在这项多中心试验中，研究组随机分配了2928名最近入住ICU的成人患者（随机分组前≤12小时），这些患者在开放系统中每分钟接受至少10升氧气，或在封闭系统中吸入的氧气分数至少为0.50，分别接受PaO₂目标为60 mm Hg（低氧合组）或90 mm Hg（高氧合组）的氧气治疗，最长90天。主要结局是90天内的死亡率。

90天时，低氧合组1441例患者中有618例（42.9%）死亡，高氧合组1447例患者中有613例（42.4%）死亡，组间差异不显著。在90天时，患者在没有生命支持的情况下存活天数百分比，或出院后存活天数百分比在组间没有显著差异。两组新发休克、心肌缺血、缺血性中风或肠缺血的患者比例相差不大。

研究结果表明，对于ICU的急性低氧血症性呼吸衰竭的成人患者，采用较低的氧合目标与较高目标相比，并不能降低90天时的死亡率。

附：英文原文

Title: Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure | NEJM

Author: Olav L. Schjrring, M.D., Ph.D.,, Thomas L. Klitgaard, M.D.,, Anders Perner, M.D., Ph.D.,, Jrn Wetterslev, M.D., Ph.D.,, Theis Lange, Ph.D.,, Martin Siegemund, M.D.,, Minna Bcklund, M.D., Ph.D.,, Frederik Keus, M.D.,, Jon H. Laake, M.D., Ph.D.,, Matthew Morgan, M.D., Ph.D.,, Katrin M. Thormar, M.D., Ph.D.,, Sren A. Rosborg, M.D., Ph.D.,, Jannie Bisgaard, M.D., Ph.D.,, Annette E.S. Erntgaard, M.D.,, Anne-Sofie H. Lynnerup, M.D.,, Rasmus L. Pedersen, M.D.,, Elena Crescioli, M.D.,, Theis C. Gielstrup, M.D.,, Meike T. Behzadi, M.D.,, Lone M. Poulsen, M.D.,, Stine Estrup, M.D., Ph.D.,, Jens P. Laigaard, M.S.,, Cheme Andersen, M.D.,, Camilla B. Mortensen, R.N.,, Bjrn A. Brand, M.D.,, Jonathan White, M.D., Ph.D.,, Inge-Lise Jarnvig, M.D., Ph.D.,, Morten H. Mller, M.D., Ph.D.,, Lars Quist, M.D., Ph.D.,, Morten H. Bestle, M.D., Ph.D.,, Martin Schnemann-Lund, M.D.,, Maj K. Kamper, M.D.,, Mathias Hindborg, M.D.,, Alexa Hollinger, M.D.,, Caroline E. Gebhard, M.D.,, Núria Zellweger, M.Sc.,, Christian S. Meyhoff, M.D., Ph.D.,, Mathias Hjort, M.D.,, Laura K. Bech, M.Sc.,, Thorbjrn Grfte, M.D., Ph.D.,, Helle Bundgaard, M.D., Ph.D.,, Lars H.M. stergaard, M.D.,, Maria A. Thy, M.D.,, Thomas Hildebrandt, M.D.,, Bülent Uslu, M.D.,, Christoffer G. Slling, M.D., Ph.D.,, Nette Mller-Nielsen, M.D.,, Anne C. Brchner, M.D., Ph.D.,, Morten Borup, M.D., Ph.D.,, Marjatta Okkonen, M.D., Ph.D.,, Willem Dieperink, Ph.D.,, Ulf G. Pedersen, M.D.,, Anne S. Andreasen, M.D., Ph.D.,, Lone Buus, M.D.,, Tayyba N. Aslam, M.D.,, Robert R. Winding, M.D.,, Joerg C. Schefold, M.D.,, Stine B. Thorup, M.D.,, Susanne A. Iversen, M.D.,, Janus Engstrm, B.Sc.,, Maj-Brit N. Kjr, R.N.,, and Bodil S. Rasmussen, M.D., Ph.D.

Issue&Volume: 2021-01-20

Abstract:

Background

Patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are treated with supplemental oxygen, but the benefits and harms of different oxygenation targets are unclear. We hypothesized that using a lower target for partial pressure of arterial oxygen (Pao2) would result in lower mortality than using a higher target.

Methods

In this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (≤12 hours before randomization) and who were receiving at least 10 liters of oxygen per minute in an open system or had a fraction of inspired oxygen of at least 0.50 in a closed system to receive oxygen therapy targeting a Pao2 of either 60 mm Hg (lower-oxygenation group) or 90 mm Hg (higher-oxygenation group) for a maximum of 90 days. The primary outcome was death within 90 days.

Results

At 90 days, 618 of 1441 patients (42.9%) in the lower-oxygenation group and 613 of 1447 patients (42.4%) in the higher-oxygenation group had died (adjusted risk ratio, 1.02; 95% confidence interval, 0.94 to 1.11; P=0.64). At 90 days, there was no significant between-group difference in the percentage of days that patients were alive without life support or in the percentage of days they were alive after hospital discharge. The percentages of patients who had new episodes of shock, myocardial ischemia, ischemic stroke, or intestinal ischemia were similar in the two groups (P=0.24).

Conclusions

Among adult patients with acute hypoxemic respiratory failure in the ICU, a lower oxygenation target did not result in lower mortality than a higher target at 90 days.

DOI: 10.1056/NEJMoa2032510

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2032510