NEJM:动脉氧分压治疗目标对急性低氧性呼吸衰竭患者死亡风险的影响

2021-01-21 MedSci原创 MedSci原创

对于因急性低氧性呼吸衰竭接受ICU治疗的患者,降低动脉氧分压治疗目标至60mmHG不能降低患者死亡风险

因急性低氧性呼吸衰竭接受ICU治疗的患者往往接受高氧浓度的吸氧治疗,以提高动脉氧分压(Pao2)。部分研究发现,过高的动脉氧分压可能与患者死亡风险增加相关:小规模研究发现,目标周围血氧饱和度为88%-92%,相比于96%以上对患者更有益;单中心研究发现,目标Pao2在70-100mgHg患者的死亡率低于Pao2目标在150mmHg。近日研究人员考察了动脉氧分压治疗目标对急性低氧性呼吸衰竭死亡风险的影响。
 
HOT-ICU研究为一项多中心,随机研究,2928名因急性低氧性呼吸衰竭接受ICU监护的患者参与,患者接受吸氧治疗,目标Pao2 为60 mm Hg(低氧分压组)或90 mm Hg(高氧分压组),随访90天。研究的主要结局是90天内死亡。
 
90天时,低氧分压组1441例患者中有618例(42.9%)死亡,高氧分压组1447例患者中有613例(42.4%)死亡(校正风险比:1.02)。在90天时,组间患者在无生命支持系统情况下存活天数百分比或出院后存活天数百分比无显著差异。组间新发休克、心肌缺血、缺血性脑卒中或肠缺血风险相似(P=0.24)。
 
研究认为,对于因急性低氧性呼吸衰竭接受ICU治疗的患者,降低动脉氧分压治疗目标至60mmHG不能降低患者死亡风险
 
原始出处:
 
Olav L. Schjorring et al. Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure. N Engl J Med, January 20 2021.

 

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    2021-03-23 病毒猎手

    因急性低氧性#呼吸衰竭#接受ICU治疗的患者,降低#动脉氧分压#治疗目标至60mmHG不能降低患者死亡风险。说明降低氧分压仍然是悬疑!

    0

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    2021-02-04 skywalk3004

    学习

    0

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    2021-01-25 1e0d07f0m53(暂无匿称)

    带教老师跟我讲氧合稳定下氧浓度越低越好,验证了

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1983703, encodeId=7a921983e0366, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Thu Aug 19 16:01:15 CST 2021, time=2021-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=950267, encodeId=855595026e02, content=因急性低氧性<a href='/topic/show?id=955c396991e' target=_blank style='color:#2F92EE;'>#呼吸衰竭#</a>接受ICU治疗的患者,降低<a href='/topic/show?id=5e6d332510f' target=_blank style='color:#2F92EE;'>#动脉氧分压#</a>治疗目标至60mmHG不能降低患者死亡风险。说明降低氧分压仍然是悬疑!, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39699, encryptionId=955c396991e, topicName=呼吸衰竭), TopicDto(id=33251, encryptionId=5e6d332510f, topicName=动脉氧分压)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Tue Mar 23 09:33:46 CST 2021, time=2021-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922711, encodeId=ff80922e1138, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210119/c927ceda7130411b9f6039935627a2e6/4c85aa535b1b459ea6166ab0917ee636.jpg, createdBy=418b3050927, createdName=skywalk3004, createdTime=Thu Feb 04 09:20:51 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919839, encodeId=5960919839b2, content=带教老师跟我讲氧合稳定下氧浓度越低越好,验证了, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3ccd1932112, createdName=1e0d07f0m53(暂无匿称), createdTime=Mon Jan 25 20:00:26 CST 2021, time=2021-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256048, encodeId=78d71256048de, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Jan 23 11:01:15 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449549, encodeId=aa6a14495490e, content=<a href='/topic/show?id=d7255218e53' target=_blank style='color:#2F92EE;'>#急性低氧性呼吸衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52187, encryptionId=d7255218e53, topicName=急性低氧性呼吸衰竭)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jan 23 11:01:15 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035557, encodeId=69ef103555e23, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 21 23:01:15 CST 2021, time=2021-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918786, encodeId=0ac6918e8696, content=这个很好,能清晰的明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/0a9886004a4c487fb51676c78a206e87/e0002d6100c343408254a09ec8bc3b51.jpg, createdBy=d2ec5454797, createdName=宗杰, createdTime=Thu Jan 21 20:52:50 CST 2021, time=2021-01-21, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1983703, encodeId=7a921983e0366, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Thu Aug 19 16:01:15 CST 2021, time=2021-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=950267, encodeId=855595026e02, content=因急性低氧性<a href='/topic/show?id=955c396991e' target=_blank style='color:#2F92EE;'>#呼吸衰竭#</a>接受ICU治疗的患者,降低<a href='/topic/show?id=5e6d332510f' target=_blank style='color:#2F92EE;'>#动脉氧分压#</a>治疗目标至60mmHG不能降低患者死亡风险。说明降低氧分压仍然是悬疑!, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39699, encryptionId=955c396991e, topicName=呼吸衰竭), TopicDto(id=33251, encryptionId=5e6d332510f, topicName=动脉氧分压)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Tue Mar 23 09:33:46 CST 2021, time=2021-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922711, encodeId=ff80922e1138, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210119/c927ceda7130411b9f6039935627a2e6/4c85aa535b1b459ea6166ab0917ee636.jpg, createdBy=418b3050927, createdName=skywalk3004, createdTime=Thu Feb 04 09:20:51 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919839, encodeId=5960919839b2, content=带教老师跟我讲氧合稳定下氧浓度越低越好,验证了, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3ccd1932112, createdName=1e0d07f0m53(暂无匿称), createdTime=Mon Jan 25 20:00:26 CST 2021, time=2021-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256048, encodeId=78d71256048de, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Jan 23 11:01:15 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449549, encodeId=aa6a14495490e, content=<a href='/topic/show?id=d7255218e53' target=_blank style='color:#2F92EE;'>#急性低氧性呼吸衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52187, encryptionId=d7255218e53, topicName=急性低氧性呼吸衰竭)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jan 23 11:01:15 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035557, encodeId=69ef103555e23, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 21 23:01:15 CST 2021, time=2021-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918786, encodeId=0ac6918e8696, content=这个很好,能清晰的明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/0a9886004a4c487fb51676c78a206e87/e0002d6100c343408254a09ec8bc3b51.jpg, createdBy=d2ec5454797, createdName=宗杰, createdTime=Thu Jan 21 20:52:50 CST 2021, time=2021-01-21, status=1, ipAttribution=)]
    2021-01-21 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1983703, encodeId=7a921983e0366, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Thu Aug 19 16:01:15 CST 2021, time=2021-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=950267, encodeId=855595026e02, content=因急性低氧性<a href='/topic/show?id=955c396991e' target=_blank style='color:#2F92EE;'>#呼吸衰竭#</a>接受ICU治疗的患者,降低<a href='/topic/show?id=5e6d332510f' target=_blank style='color:#2F92EE;'>#动脉氧分压#</a>治疗目标至60mmHG不能降低患者死亡风险。说明降低氧分压仍然是悬疑!, beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39699, encryptionId=955c396991e, topicName=呼吸衰竭), TopicDto(id=33251, encryptionId=5e6d332510f, topicName=动脉氧分压)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Tue Mar 23 09:33:46 CST 2021, time=2021-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922711, encodeId=ff80922e1138, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210119/c927ceda7130411b9f6039935627a2e6/4c85aa535b1b459ea6166ab0917ee636.jpg, createdBy=418b3050927, createdName=skywalk3004, createdTime=Thu Feb 04 09:20:51 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919839, encodeId=5960919839b2, content=带教老师跟我讲氧合稳定下氧浓度越低越好,验证了, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3ccd1932112, createdName=1e0d07f0m53(暂无匿称), createdTime=Mon Jan 25 20:00:26 CST 2021, time=2021-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256048, encodeId=78d71256048de, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Jan 23 11:01:15 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449549, encodeId=aa6a14495490e, content=<a href='/topic/show?id=d7255218e53' target=_blank style='color:#2F92EE;'>#急性低氧性呼吸衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52187, encryptionId=d7255218e53, topicName=急性低氧性呼吸衰竭)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jan 23 11:01:15 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035557, encodeId=69ef103555e23, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 21 23:01:15 CST 2021, time=2021-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918786, encodeId=0ac6918e8696, content=这个很好,能清晰的明白, beContent=null, objectType=article, channel=null, level=null, likeNumber=150, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/0a9886004a4c487fb51676c78a206e87/e0002d6100c343408254a09ec8bc3b51.jpg, createdBy=d2ec5454797, createdName=宗杰, createdTime=Thu Jan 21 20:52:50 CST 2021, time=2021-01-21, status=1, ipAttribution=)]
    2021-01-21 宗杰

    这个很好,能清晰的明白

    0

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