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[Lancet最新论文]:成年急性病患者接受自由或保守氧疗的病死率及罹患率
2018年05月04日 时讯速递, 进展交流 暂无评论

Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis

Derek K Chu, Lisa H-Y Kim, Paul J Young, et al.

Lancet 2018; 391: 1693-1705

Summary

Background 背景

Supplemental oxygen is often administered liberally to acutely ill adults, but the credibility of the evidence for this practice is unclear. We systematically reviewed the efficacy and safety of liberal versus conservative oxygen therapy in acutely ill adults.

氧疗常常自由用于急性病患者,但其证据并不明确。我们对急性病患者接受自由及保守氧疗的疗效及安全性进行了系统回顾。

Methods 方法

In the Improving Oxygen Therapy in Acute-illness (IOTA) systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, HealthSTAR, LILACS, PapersFirst, and the WHO International Clinical Trials Registry from inception to Oct 25, 2017, for randomised controlled trials comparing liberal and conservative oxygen therapy in acutely ill adults (aged ≥18 years). Studies limited to patients with chronic respiratory diseases or psychiatric disease, patients on extracorporeal life support, or patients treated with hyperbaric oxygen therapy or elective surgery were excluded. We screened studies and extracted summary estimates independently and in duplicate. We also extracted individual patient-level data from survival curves. The main outcomes were mortality (in-hospital, at 30 days, and at longest follow-up) and morbidity (disability at longest follow-up, risk of hospital-acquired pneumonia, any hospital-acquired infection, and length of hospital stay) assessed by random-effects meta-analyses. We assessed quality of evidence using the grading of recommendations assessment, development, and evaluation approach. This study is registered with PROSPERO, number CRD42017065697.

在急性病改进氧疗(IOTA)系统回顾与meta分析中,我们对Cochrane Central Register of Controlled Trials、MEDLINE、Embase、HealthSTAR、LILACS、PapersFirst及WHO International Clinical Trials Registry进行检索,检索期间直至2017年10月25日,入选比较成年(年龄≥18岁)急性病患者接受自由或保守氧疗的随机对照试验。研究对象为慢性呼吸系统疾病或精神疾病患者,接受体外生命支持治疗的患者,或接受高压氧治疗或择期手术患者的研究被排除。我们对研究进行了筛选,研究者独立且重复进行研究结果的总结。我们还从生存曲线获取每名患者的资料。主要预后终点为病死率(住院病死率,30天病死率,及最长随访时间)及罹患率(最长随访时的残疾率,医院获得性肺炎的风险,任何医院获得性感染,住院日),采用随机效应meta分析进行评价。我们采用GRADE法评价证据质量。研究在PROSPERO注册,注册号CRD42017065697。

Findings 结果

25 randomised controlled trials enrolled 16 037 patients with sepsis, critical illness, stroke, trauma, myocardial infarction, or cardiac arrest, and patients who had emergency surgery. Compared with a conservative oxygen strategy, a liberal oxygen strategy (median baseline saturation of peripheral oxygen [SpO2] across trials, 96% [range 94–99%, IQR 96–98]) increased mortality in-hospital (relative risk [RR] 1·21, 95% CI 1·03–1·43, I2=0%, high quality), at 30 days (RR 1·14, 95% CI 1·01–1·29, I2=0%, high quality), and at longest follow-up (RR 1·10, 95% CI 1·00–1·20, I2=0%, high quality). Morbidity outcomes were similar between groups. Findings were robust to trial sequential, subgroup, and sensitivity analyses.

25项随机对照试验入选,共有16037名全身性感染、危重病、卒中、创伤、心梗、心跳骤停及急诊手术患者。与保守氧疗策略相比,自由氧疗策略(外周氧饱和度[SpO2]基线水平中位数96% [范围94-99%,IQR 96-98])增加住院病死率(相对危险度 [RR] 1·21, 95% CI 1·03–1·43, I2=0%, 高质量),30天病死率(RR 1·14, 95% CI 1·01–1·29, I2=0%, 高质量)以及最长随访时间的病死率(RR 1·10, 95% CI 1·00–1·20, I2=0%, 高质量)。

Interpretation 结论

In acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Supplemental oxygen might become unfavourable above an SpO2 range of 94–96%. These results support the conservative administration of oxygen therapy.

对于成年急性病患者,高质量证据显示,自由氧疗增加病死率且不改善其他对于患者重要的预后指标。SpO2 超过 94–96%时,氧疗不再获益。这些结果支持氧疗的保守策略。

Funding 资助

None.

 

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