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[NEJM在线发表]:ICU机械通气期间保守氧疗不增加无呼吸机天数
2019年10月19日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

Conservative Oxygen Therapy during Mechanical Ventilation in the ICU

The ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group

N Engl J Med October 14, 2019
DOI: 10.1056/NEJMoa1903297

BACKGROUND 背景

Patients who are undergoing mechanical ventilation in the intensive care unit (ICU) often receive a high fraction of inspired oxygen (Fio2) and have a high arterial oxygen tension. The conservative use of oxygen may reduce oxygen exposure, diminish lung and systemic oxidative injury, and thereby increase the number of ventilator-free days (days alive and free from mechanical ventilation).

在ICU中接受机械通气的患者吸入氧浓度 (Fio2) 常常很高,因而动脉氧分压很高。保守氧疗可能减少氧的暴露,减少肺和全身性氧化损伤,因而增加无呼吸机天数(存活且无需机械通气)。

METHODS 方法

We randomly assigned 1000 adult patients who were anticipated to require mechanical ventilation beyond the day after recruitment in the ICU to receive conservative or usual oxygen therapy. In the two groups, the default lower limit for oxygen saturation as measured by pulse oximetry (Spo2) was 90%. In the conservative-oxygen group, the upper limit of the Spo2 alarm was set to sound when the level reached 97%, and the Fio2 was decreased to 0.21 if the Spo2 was above the acceptable lower limit. In the usual-oxygen group, there were no specific measures limiting the Fio2 or the Spo2. The primary outcome was the number of ventilator-free days from randomization until day 28.

我们将预期需要机械通气超过1天的1000名成年患者随机分为保守或常规氧疗组。两组患者默认的脉搏氧饱和度(Spo2)下限为90%。保守氧疗组Spo2的报警上限设置为97%,如果Spo2超过可以接受的下限,则可将Spo2降低至0.21。常规氧疗组对于Fio2 或 Spo2 没有限制。主要预后指标为从随机分组至28天时无呼吸机天数。

RESULTS 结果

The number of ventilator-free days did not differ significantly between the conservative-oxygen group and the usual-oxygen group, with a median duration of 21.3 days (interquartile range, 0 to 26.3) and 22.1 days (interquartile range, 0 to 26.2), respectively, for an absolute difference of −0.3 days (95% confidence interval [CI], −2.1 to 1.6; P=0.80). The conservative-oxygen group spent more time in the ICU with an Fio2of 0.21 than the usual-oxygen group, with a median duration of 29 hours (interquartile range, 5 to 78) and 1 hour (interquartile range, 0 to 17), respectively (absolute difference, 28 hours; 95% CI, 22 to 34); the conservative-oxygen group spent less time with an Spo2exceeding 96%, with a duration of 27 hours (interquartile range, 11 to 63.5) and 49 hours (interquartile range, 22 to 112), respectively (absolute difference, 22 hours; 95% CI, 14 to 30). At 180 days, mortality was 35.7% in the conservative-oxygen group and 34.5% in the usual-oxygen group, for an unadjusted odds ratio of 1.05 (95% CI, 0.81 to 1.37).

保守和常规氧疗组无呼吸机天数没有显著差异,其中位数分别为21.3 天(四分位区间,0 to 26.3) 和 22.1 天 (四分位区间, 0 to 26.2),绝对差异 −0.3 天 (95%可信区间[CI], −2.1 to 1.6; P=0.80)。在ICU期间,保守氧疗组Fio2维持 0.21 的时间较常规氧疗组更长,中位数分别为 29 小时 (四分位区间, 5 to 78) 和 1 小时 (四分位区间, 0 to 17) (绝对差异, 28 小时; 95% CI, 22 to 34);保守氧疗组Spo2超过 96%的时间短于常规氧疗组,分别为 27 小时 (四分位区间, 11 to 63.5) 和 49 小时 (四分位区间, 22 to 112) (绝对差异, 22 小时; 95% CI, 14 to 30)。至180天时,保守氧疗组病死率 35.7%,常规氧疗组病死率 34.5%,未校正比数比 1.05 (95% CI, 0.81 to 1.37)。

CONCLUSIONS 结论

In adults undergoing mechanical ventilation in the ICU, the use of conservative oxygen therapy, as compared with usual oxygen therapy, did not significantly affect the number of ventilator-free days.

对于在ICU中接受机械通气的成年患者,与常规氧疗相比,保守氧疗不能显著影响无呼吸机天数。

(Funded by the New Zealand Health Research Council; ICU-ROX Australian and New Zealand Clinical Trials Registry number, ACTRN12615000957594. opens in new tab.)

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