학술논문
Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study.
Document Type
Academic Journal
Author
Madotto F; Research Center on Public Health, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Scientific Institute for Research, Hospitalization and Health Care, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.; Rezoagli E; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland.; Pham T; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Canada.; Department of Critical Care Medicine, St Michael's Hospital, Toronto, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Schmidt M; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; McNicholas B; Nephrology, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Protti A; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy.; Humanits clinical and research center - IRCCS, Rozzano (Milan), Italy.; Panwar R; Intensive Care Unit, John Hunter Hospital, New Lambton Heights, NSW, Australia.; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.; Bellani G; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.; Fan E; Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Department of Medicine, University Health Network and Sinai Health System, Toronto, Canada.; van Haren F; Intensive Care Unit, The Canberra Hospital and Australian National University, Canberra, Australia.; Brochard L; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Canada.; Department of Critical Care Medicine, St Michael's Hospital, Toronto, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Laffey JG; Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland. john.laffey@nuigalway.ie.; Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland. john.laffey@nuigalway.ie.; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Canada. john.laffey@nuigalway.ie.
Source
Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study.
Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO 2 ≥ 0.60 during hyperoxemia).
Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO 2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO 2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO 2 . Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO 2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO 2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO 2 55-100 mmHg) patients (P = 0.47).
Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort.
Trial Registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073.
Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO
Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO
Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort.
Trial Registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073.