种族与观察到的氧饱和度、吸入氧比例和临床结果:氧气-重症监护病房保守吸氧试验的事后分析。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2024-10-01 Epub Date: 2024-07-19 DOI:10.1097/PCC.0000000000003583
Gareth A L Jones, Martin Wiegand, Samiran Ray, Doug W Gould, Rachel Agbeko, Elisa Giallongo, Walton N Charles, Marzena Orzol, Lauran O'Neill, Lamprini Lampro, Jon Lillie, John Pappachan, Padmanabhan Ramnarayan, David A Harrison, Paul R Mouncey, Mark J Peters
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引用次数: 0

摘要

目标在我们最近进行的氧气-重症监护病房(Oxy-PICU)试验中,对重症监护病房(PICU)中接受机械通气的患儿采取保守的氧合策略,将外周血氧饱和度(Spo2)控制在 88% 到 92% 之间,与 Spo2 超过 94% 的患儿相比,器官支持时间更短,存活率更高。与皮肤色素沉着较少的患者相比,皮肤色素沉着程度较高的患者的 Spo2 监护仪可能会高估动脉血氧饱和度(Sao2)。我们研究了种族是否与 Spo2 和 Fio2 的分布变化及结果有关:设计:对一项务实、开放标签、多中心随机对照试验的事后分析:背景:英国和苏格兰的 15 所儿童重症监护病房:方法:使用Spo2和Fio2的分层回归模型,以及30天器官支持持续时间和死亡复合的主要试验结果的序数模型,在考虑基线Spo2、Fio2和平均气道压以及试验分配的情况下,研究种族的影响:1986名符合条件的儿童中有1577名有种族数据,其中1408名(89.3%)为白人、亚裔或黑人。与白人儿童相比,黑人或亚裔儿童的 Spo2 和 Fio2 分布没有差异。试验的主要结果也未因种族而有显著差异。黑人儿童保守吸氧治疗效果的点估计值为 0.64(95% CI,0.33-1.25),而整个试验人群的点估计值为 0.84(0.68-1.04):这些数据并未表明,PICU 机械通气患儿的预后改善与保守吸氧策略之间的关系会因种族而改变。
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Ethnicity and Observed Oxygen Saturations, Fraction of Inspired Oxygen, and Clinical Outcomes: A Post-Hoc Analysis of the Oxy-PICU Trial of Conservative Oxygenation.

Objectives: A conservative oxygenation strategy, targeting peripheral oxygen saturations (Sp o2 ) between 88% and 92% in mechanically ventilated children in PICU, was associated with a shorter duration of organ support and greater survival compared with Sp o2 greater than 94% in our recent Oxy-PICU trial. Sp o2 monitors may overestimate arterial oxygen saturation (Sa o2 ) in patients with higher levels of skin pigmentation compared with those with less skin pigmentation. We investigated if ethnicity was associated with changes in distributions of Sp o2 and F io2 and outcome.

Design: Post-hoc analysis of a pragmatic, open-label, multicenter randomized controlled trial.

Setting: Fifteen PICUs across the United Kingdom and Scotland.

Patients: Children aged 38 weeks corrected gestational age to 15 years accepted to a participating PICU as an unplanned admission and receiving invasive mechanical ventilation with supplemental oxygen for abnormal gas exchange.

Methods: Hierarchical regression models for Sp o2 and F io2 , and ordinal models for the primary trial outcome of a composite of the duration of organ support at 30 days and death, were used to examine the effects of ethnicity, accounting for baseline Sp o2 , F io2 , and mean airway pressure and trial allocation.

Measurements and main results: Ethnicity data were available for 1577 of 1986 eligible children, 1408 (89.3%) of which were White, Asian, or Black. Sp o2 and F io2 distributions did not vary according to Black or Asian ethnicity compared with White children. The trial primary outcome measure also did not vary significantly with ethnicity. The point estimate for the treatment effect of conservative oxygenation in Black children was 0.64 (95% CI, 0.33-1.25) compared with 0.84 (0.68-1.04) in the overall trial population.

Conclusions: These data do not suggest that the association between improved outcomes and conservative oxygenation strategy in mechanically ventilated children in PICU is modified by ethnicity.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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