Crit Care：脓毒症/脓毒性休克患者高氧血症与死亡率降低相关

Abstract

Background: Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no stud‐ ies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO2) reduces the rate of surgical‐wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO2 is associated with risk of death in adult patients with sepsis/septic shock after major surgery. 尽管人们对限制ICU患者吸氧的治疗策略越来越感兴趣，但没有研究将保守吸氧与标准吸氧在伴有脓毒症/脓毒性休克术后患者中进行比较，尽管有迹象表明它可能会改善患者预后。不过已经有研究证明，动脉血中的高氧分压(PaO₂)可降低大手术患者的手术伤口感染率和死亡率。该研究旨在评估PaO₂是否与成年脓毒症/感染性休克患者大手术后的死亡风险相关。

Methods: We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO2 > 100 mmHg (n = 216), or PaO2 ≤ 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS‐3 criteria maintained during 48 h. Primary end‐point was 90‐day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation. 我们对一项前瞻性观察研究进行了二次分析，研究纳入了454名接受大手术并入住ICU的患者。48小时内根据sepsis3.0的标准，在脓毒症/感染性休克发作当天是否伴有高氧血症，将患者分为两组，高氧血症定义为PaO₂>100mmHg (n=216)，或PaO₂≤100mmHg (n=238)。该研究的主要终点是脓毒症诊断后的90天死亡率，次要终点是ICU住院时间和拔管时间。

Results: In patients with PaO2 ≤ 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days,
p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90‐day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90‐day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39–0.95, p = 0.029), independent of age, chronic renal failure, procalciton in levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded. 在PaO₂≤100mmHg的患者中，我们发现机械通气时间延长（2[8] vs 1[4]天，p<0.001），ICU停留时间更长（8[13] vs 5[9]天，p<0.001），通过SOFA评分评估的器官功能障碍严重程度较高（9[3] vs 7[5]，p<0.001），感染性休克的患病率较高（200/238，84.0% vs 145/216）67.1%，p<0.001)以及90天死亡率更高（37.0%[88] vs 25.5%[55]，p=0.008）。在多变量分析中，高氧血症与较高的90天生存率相关（OR为0.61，95%CI为0.39-0.95，p=0.029），而与年龄、慢性肾功能衰竭、降钙素原水平和APACHEII评分>19无关。当排除研究纳入时患有严重低氧血症的患者时，这些结果也得到了证实。

Conclusions: Oxygenation with a PaO2 above 100 mmHg was independently associated with lower 90‐day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO2 in postsurgical patients with severe infections. PaO₂高于100mmHg与重症术后脓毒症/感染性休克患者的90天死亡率降低、ICU住院时间缩短和插管时间缩短独立相关。我们的发现为设计临床试验来评估严重感染术后患者PaO2的边界开辟了一个新的场所。

【来源】：Marta Martín-Fernández,et al.Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality.Critical Care.2022.