Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study

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• 作者：Glenn M. Eastwood^a ; ^b ; ^c ; ^{glenn.eastwood@austin.org.au" class="auth_mail" title="E-mail the corresponding author} ; Aiko Tanaka^a ; ^d ; ^{aiko.tanaka@austin.org.au" class="auth_mail" title="E-mail the corresponding author} ; Emilo Daniel Valenzuela Espinoza^a ; ^{edve84@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Leah Peck^a ; ^{leah.peck@austin.org.au" class="auth_mail" title="E-mail the corresponding author} ; Helen Young^a ; ^{helen.young@austin.org.au" class="auth_mail" title="E-mail the corresponding author} ; Johan Må ; rtensson^a ; ^c ; ^e ; ^{johan.martensson@austin.org.au" class="auth_mail" title="E-mail the corresponding author} ; Ling Zhang^a ; ^f ; ^{zhanglinglzy@163.com" class="auth_mail" title="E-mail the corresponding author} ; Neil J. Glassford^a ; ^d ; ^{neil.glassford@austin.org.au" class="auth_mail" title="E-mail the corresponding author} ; Yu-Feng Frank Hsiao^a ; ^{frank.yfh@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Satoshi Suzuki^f ; ^{Suzuki-s@mtc.biglobe.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Rinaldo Bellomo^a ; ^c ; ^{rinaldo.bellomo@austin.org.au" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Oxygen ; Cardiac arrest ; Mechanical ventilation ; Mortality ; Outcome ; Intensive care
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：101
• 期：Complete
• 页码：108-114
• 全文大小：621 K

文摘

In mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both.

Methods

We evaluated the introduction of conservative oxygen therapy (target SpO₂ 88–92% using the lowest FiO₂) during MV for resuscitated CA patients admitted to the ICU.

Results

We studied 912 arterial blood gas (ABG) datasets: 448 ABGs from 50 ‘conventional’ and 464 ABGs from 50 ‘conservative’ oxygen therapy patients. Compared to the conventional group, conservative group patients had significantly lower PaO₂ values and FiO₂ exposure (p < 0.001, respectively); more received MV in a spontaneous ventilation mode (18% vs 2%; p = 0.001) and more were exposed to a FiO₂ of 0.21 (19 vs 0 patients, p = 0.001). Additionally, according to mean PaO₂, more conservative group patients were classified as normoxaemic (36 vs 16 patients, p < 0.01) and fewer as hyperoxaemic (14 vs 33 patients, p < 0.01). Finally, ICU length of stay was significantly shorter for conservative group patients (p = 0.04). There was no difference in the proportion of survivors discharged from hospital with good neurological outcome (14/23 vs 12/22 patients, p = 0.67).

Conclusions

Our findings provide preliminary support for the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU for MV support after cardiac arrest (Trial registration, class="interref" data-locatorType="ctgov" data-locatorKey="NCT01684124">NCT01684124).