BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in i...BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased.Patients may be at a risk of oxygen toxicity because of the liberal oxygen strategy.Therefore,further research is needed to improve oxygen management for patients with MV in the ICUs.展开更多
Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous p...Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F<sub>1</sub>O<sub>2</sub> include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O<sub>2</sub> CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O<sub>2</sub> to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O<sub>2</sub> CPAP (60% CPAP group, n = 35), or 100% O<sub>2</sub> CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH<sub>2</sub>O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO<sub>2</sub> value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO<sub>2</sub> value than the 60% CPAP group (p = 0.0495). The SaO<sub>2</sub> at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO<sub>2</sub> values (p = 0.44) and SaO<sub>2</sub> values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O<sub>2</sub> OLV and 60% O<sub>2</sub> CPAP. The application of 60% O<sub>2</sub> CPAP during OLV for patients who are not suited to exposure to high F<sub>1</sub>O<sub>2</sub> may be an alternative form of respiratory management.展开更多
目的:构建机械通气患者伴发高氧血症的预测模型,并验证其预测价值。方法:回顾性分析2020年1月至2021年3月南方医科大学第三附属医院重症医学科147例接受机械通气患者的临床资料,根据机械通气72 h最高动脉氧分压是否≥120 mm Hg分为高氧...目的:构建机械通气患者伴发高氧血症的预测模型,并验证其预测价值。方法:回顾性分析2020年1月至2021年3月南方医科大学第三附属医院重症医学科147例接受机械通气患者的临床资料,根据机械通气72 h最高动脉氧分压是否≥120 mm Hg分为高氧血症组(94例)和非高氧血症组(53例)。收集入选患者性别、年龄、体重指数、急性生理学与慢性健康状况评估(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、合并慢性疾病、收治原因、机械通气原因、机械通气参数、循环指标及实验室检查结果。对2组患者的临床数据进行单因素、Logistic多因素分析,通过独立危险因素的回归系数构建预测模型;采用受试者工作特征(ROC)曲线对比预测模型与各原始协变量ROC曲线下面积(AUC),以约登指数最大时确定最佳临界值,计算敏感度、特异性及预测准确性等工作性能参数。将预测模型应用于2022年1月至6月53例机械通气患者,验证其预测效能。结果:单因素分析结果显示,机械通气伴发高氧血症与SOFA评分、因内科疾患转入、肺部病变、因意识状态改变上机、持续正压气道通气(CPAP)、同步间歇指令通气、血乳酸及血红蛋白水平相关(P均<0.05)。Logistic多因素分析显示年龄(X_(1))、SOFA评分(X_(2))、因内科疾患转入(X_(3))、因意识状态改变上机(X_(4))、使用CPAP(X_(5))是机械通气患者发生高氧血症的独立危险因素(P均<0.05)。预测模型Y=4.317-0.036X_(1)-0.183X_(2)+1.699X_(3)-2.045X_(4)-1.864X_(5)。Hosmer-Lemeshow拟合优度检验χ^(2)=10.202,P=0.177。绘制ROC曲线,预测模型AUC为0.817。预测模型的最佳临界值为0.404。预测模型预测机械通气伴发高氧血症的AUC高于年龄、SOFA评分、因内科疾患转入、因意识状态改变上机、使用CPAP模式单独预测时的AUC(0.817 vs.0.574、0.651、0.609、0.554、0.641)。将预测模型和最佳临界值应用于53例机械通气患者作为验证,预测正确率为79.2%,敏感度80.6%,特异性77.3%,阳性预测值83.3%,阴性预测值73.9%,阳性似然比3.551,阴性似然比0.251。结论:使用Logistic回归构建的预测模型对机械通气伴发高氧血症有较好的预测价值。展开更多
文摘BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased.Patients may be at a risk of oxygen toxicity because of the liberal oxygen strategy.Therefore,further research is needed to improve oxygen management for patients with MV in the ICUs.
文摘Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F<sub>1</sub>O<sub>2</sub> include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O<sub>2</sub> CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O<sub>2</sub> to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O<sub>2</sub> CPAP (60% CPAP group, n = 35), or 100% O<sub>2</sub> CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH<sub>2</sub>O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO<sub>2</sub> value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO<sub>2</sub> value than the 60% CPAP group (p = 0.0495). The SaO<sub>2</sub> at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO<sub>2</sub> values (p = 0.44) and SaO<sub>2</sub> values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O<sub>2</sub> OLV and 60% O<sub>2</sub> CPAP. The application of 60% O<sub>2</sub> CPAP during OLV for patients who are not suited to exposure to high F<sub>1</sub>O<sub>2</sub> may be an alternative form of respiratory management.
文摘目的:构建机械通气患者伴发高氧血症的预测模型,并验证其预测价值。方法:回顾性分析2020年1月至2021年3月南方医科大学第三附属医院重症医学科147例接受机械通气患者的临床资料,根据机械通气72 h最高动脉氧分压是否≥120 mm Hg分为高氧血症组(94例)和非高氧血症组(53例)。收集入选患者性别、年龄、体重指数、急性生理学与慢性健康状况评估(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、合并慢性疾病、收治原因、机械通气原因、机械通气参数、循环指标及实验室检查结果。对2组患者的临床数据进行单因素、Logistic多因素分析,通过独立危险因素的回归系数构建预测模型;采用受试者工作特征(ROC)曲线对比预测模型与各原始协变量ROC曲线下面积(AUC),以约登指数最大时确定最佳临界值,计算敏感度、特异性及预测准确性等工作性能参数。将预测模型应用于2022年1月至6月53例机械通气患者,验证其预测效能。结果:单因素分析结果显示,机械通气伴发高氧血症与SOFA评分、因内科疾患转入、肺部病变、因意识状态改变上机、持续正压气道通气(CPAP)、同步间歇指令通气、血乳酸及血红蛋白水平相关(P均<0.05)。Logistic多因素分析显示年龄(X_(1))、SOFA评分(X_(2))、因内科疾患转入(X_(3))、因意识状态改变上机(X_(4))、使用CPAP(X_(5))是机械通气患者发生高氧血症的独立危险因素(P均<0.05)。预测模型Y=4.317-0.036X_(1)-0.183X_(2)+1.699X_(3)-2.045X_(4)-1.864X_(5)。Hosmer-Lemeshow拟合优度检验χ^(2)=10.202,P=0.177。绘制ROC曲线,预测模型AUC为0.817。预测模型的最佳临界值为0.404。预测模型预测机械通气伴发高氧血症的AUC高于年龄、SOFA评分、因内科疾患转入、因意识状态改变上机、使用CPAP模式单独预测时的AUC(0.817 vs.0.574、0.651、0.609、0.554、0.641)。将预测模型和最佳临界值应用于53例机械通气患者作为验证,预测正确率为79.2%,敏感度80.6%,特异性77.3%,阳性预测值83.3%,阴性预测值73.9%,阳性似然比3.551,阴性似然比0.251。结论:使用Logistic回归构建的预测模型对机械通气伴发高氧血症有较好的预测价值。
