Background::To investigate the relationship between partial pressure of oxygen(PaO_(2))/fraction of inspired oxygen(FiO_(2))and the probability of delirium in intensive care units(ICUs).Methods::The investigation was ...Background::To investigate the relationship between partial pressure of oxygen(PaO_(2))/fraction of inspired oxygen(FiO_(2))and the probability of delirium in intensive care units(ICUs).Methods::The investigation was a cross-sectional study that involved the collection of data from patients admitted to the Xiang Ya Hospital Cardiothoracic Surgical Care Unit and Comprehensive Intensive Care Unit from 01 September 2016 to 10 December 2016.Delirium was diagnosed using the simplified version of the Chinese Confusion Assessment Method(CAM)for the ICU.Demographic and medical data were obtained within 24 h of each patient admitted in the ICU.The PaO_(2)/FiO_(2) of each patient was recorded 24 h after admission in the ICU.The patients were divided into three groups according to PaO_(2)/FiO_(2) data:normal(PaO_(2)/FiO_(2)≥300 mmHg),slightly low(200≥PaO_(2)/FiO_(2)<300 mmHg),and severely low(PaO_(2)/FiO_(2)<200 mmHg).Baseline characteristics were compared in the three groups.Results of the unadjusted model,minimally adjusted model,and fully adjusted model are presented.Results::A total of 403 participants were included in the study,of which 184(45.7%)developed delirium.Age(P<0.001),Sequential Organ Failure Assessment(SOFA)score(P<0.001),Acute Physiology and Chronic Health Evaluation(APACHE)II score(P<0.001),mechanical ventilation time(P<0.001),history of hypertension(P=0.040),heart disease(P=0.040),sedation(P=0.001),and PaO_(2)/FiO_(2)(P=0.006)were significantly associated with delirium in univariate analysis.Multivariate regression analysis models were used to further analyze the associations between PaO_(2)/FiO_(2) and delirium.In the crude model,for 1 standard deviation(SD)increase in PaO_(2)/FiO_(2),the odds ratio(OR)of delirium was 0.8(95%confidence interval[CI]:0.6-0.9),but there was no significant correlation in the fully adjusted model.There was a non-linear relationship between the PaO_(2)/FiO_(2) and delirium in a generalized additive model.A two-piecewise linear regression model was used to calculate a PaO_(2)/FiO_(2) threshold of 243 mmHg.On the left side of the threshold,the OR was 0.9 and the 95%CI was 0.9-1.0(P=0.013)when PaO_(2)/FiO_(2) increased by 1 SD.Conclusions::PaO_(2)/FiO_(2) was negatively associated with delirium when PaO_(2)/FiO_(2) was below the identified threshold.As a readily available laboratory indicator,PaO_(2)/FiO_(2) has potential value in the clinical evaluation of risk of delirium in ICU patients.展开更多
文摘Background::To investigate the relationship between partial pressure of oxygen(PaO_(2))/fraction of inspired oxygen(FiO_(2))and the probability of delirium in intensive care units(ICUs).Methods::The investigation was a cross-sectional study that involved the collection of data from patients admitted to the Xiang Ya Hospital Cardiothoracic Surgical Care Unit and Comprehensive Intensive Care Unit from 01 September 2016 to 10 December 2016.Delirium was diagnosed using the simplified version of the Chinese Confusion Assessment Method(CAM)for the ICU.Demographic and medical data were obtained within 24 h of each patient admitted in the ICU.The PaO_(2)/FiO_(2) of each patient was recorded 24 h after admission in the ICU.The patients were divided into three groups according to PaO_(2)/FiO_(2) data:normal(PaO_(2)/FiO_(2)≥300 mmHg),slightly low(200≥PaO_(2)/FiO_(2)<300 mmHg),and severely low(PaO_(2)/FiO_(2)<200 mmHg).Baseline characteristics were compared in the three groups.Results of the unadjusted model,minimally adjusted model,and fully adjusted model are presented.Results::A total of 403 participants were included in the study,of which 184(45.7%)developed delirium.Age(P<0.001),Sequential Organ Failure Assessment(SOFA)score(P<0.001),Acute Physiology and Chronic Health Evaluation(APACHE)II score(P<0.001),mechanical ventilation time(P<0.001),history of hypertension(P=0.040),heart disease(P=0.040),sedation(P=0.001),and PaO_(2)/FiO_(2)(P=0.006)were significantly associated with delirium in univariate analysis.Multivariate regression analysis models were used to further analyze the associations between PaO_(2)/FiO_(2) and delirium.In the crude model,for 1 standard deviation(SD)increase in PaO_(2)/FiO_(2),the odds ratio(OR)of delirium was 0.8(95%confidence interval[CI]:0.6-0.9),but there was no significant correlation in the fully adjusted model.There was a non-linear relationship between the PaO_(2)/FiO_(2) and delirium in a generalized additive model.A two-piecewise linear regression model was used to calculate a PaO_(2)/FiO_(2) threshold of 243 mmHg.On the left side of the threshold,the OR was 0.9 and the 95%CI was 0.9-1.0(P=0.013)when PaO_(2)/FiO_(2) increased by 1 SD.Conclusions::PaO_(2)/FiO_(2) was negatively associated with delirium when PaO_(2)/FiO_(2) was below the identified threshold.As a readily available laboratory indicator,PaO_(2)/FiO_(2) has potential value in the clinical evaluation of risk of delirium in ICU patients.
文摘【目的】分析无创正压通气(non-invasive positive pressure ventilation,NPPV)对急性加重期慢性阻塞性肺疾病(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并重度Ⅱ型呼吸衰竭患者PaO2及pH值的影响。【方法】选择2017年1月至2018年12月本院收治的以AECOPD合并重度Ⅱ型呼吸衰竭为诊断,并行NPPV治疗的79例患者为实验组,另选取同期同诊断未使用NPPV,仅采取常规吸氧治疗的79例患者为对照组。对比2组患者治疗前、后血气相关指标(pH值、PaO2、PaCO2、SaO2)、肺功能相关指标[肺活量(vital capacity,VC)、用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)、FEV1/FVC]、生命体征(心率、体温、呼吸)、临床治疗效果、并发症与气管插管发生情况。【结果】治疗后,2组患者血气指标、肺功能指标、生命体征相关指标较治疗前均有明显改善,其中实验组患者pH值、PO2、SaO2及肺功能各项指标明显高于对照组,而PCO2指标明显低于对照组;实验组总有效率为97.47%,高于对照组的82.28%;实验组并发症发生率为1.27%,气管插管发生率为1.27%,明显少于对照组的12.66%、16.46%(P<0.01)。【结论】在AECOPD合并重度Ⅱ型呼吸衰竭患者的治疗中,运用NPPV可明显改善患者血气指标与肺功能,尤其是PaO2及pH值,稳定生命体征,提高临床治疗效果,并减少并发症与气管插管发生率。
