美国范德比尔特大学医学中心Matthew W. Semler团队研究了危重症成人机械通气血氧饱和度目标对患者预后的影响。相关论文于2022年10月24日发表在《新英格兰医学杂志》上。

危重病人的有创机械通气包括调整吸入氧气的比例以维持动脉血氧饱和度。在这一患者群体中，改善临床预后的血氧饱和度目标仍然未知。

研究组在一个学术中心急诊科和医疗重症监护室进行了一项务实、随机、群集交叉试验，将接受机械通气的成年患者随机分配到较低的血氧饱和度目标（通过脉搏血氧饱和度（SpO₂）测量为90%；目标范围，88至92%）、中间目标（94%；目标范围：92至96%）或更高的目标（98%；目标范围96-100%）。主要结局是第28天的存活天数和无机械通气天数（无呼吸机天数）。第二个结局是在28天内死亡，在出院时对数据进行审查。

初步分析共包括2541名患者。较低目标组患者的中位无呼吸机天数为20天，中等目标组中为21天，较高目标组中为21天，组间差异均不显著。较低目标组的808名患者中，281名（34.8%）在第28天发生院内死亡，中等目标组859名患者中有292人（34.0%），较高目标组874名患者中有290人（33.2%）。三组患者的心脏骤停、心律失常、心肌梗死、中风和气胸的发生率相似。

研究结果表明，对于接受有创机械通气的危重患者，使用较低、中等或较高SpO₂指标的各组之间无呼吸机天数没有差异。

附：英文原文

Title: Oxygen-Saturation Targets for Critically Ill Adults Receiving Mechanical Ventilation | NEJM

Author: Matthew W. Semler, M.D.,, Jonathan D. Casey, M.D.,, Bradley D. Lloyd, R.R.T.-A.C.C.S.,, Pamela G. Hastings, R.R.T.-A.C.C.S.,, Margaret A. Hays, R.N.,, Joanna L. Stollings, Pharm.D.,, Kevin G. Buell, M.B., B.S.,, John H. Brems, M.D.,, Edward T. Qian, M.D.,, Kevin P. Seitz, M.D.,, Li Wang, M.S.,, Christopher J. Lindsell, Ph.D.,, Robert E. Freundlich, M.D.,, Jonathan P. Wanderer, M.D.,, Jin H. Han, M.D.,, Gordon R. Bernard, M.D.,, Wesley H. Self, M.D., M.P.H.,, and Todd W. Rice, M.D.

Issue&Volume: 2022-10-24

Abstract:

Background

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.

Methods

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 (Spo2) (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.

Results

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.

Conclusions

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 Spo2 target was used.

DOI: 10.1056/NEJMoa2208415

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2208415