慢性阻塞性肺病加重中的氧气治疗和住院死亡率,Emergency Medicine Journal

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慢性阻塞性肺病加重中的氧气治疗和住院死亡率
Emergency Medicine Journal ( IF 2.7 ) Pub Date : 2021-03-01 , DOI: 10.1136/emermed-2019-209257
Carlos Echevarria _{1,

2} , John Steer _{2,

3} , James Wason ₄ , Stephen Bourke _{3,

5}

Affiliation

背景：在住院的慢性阻塞性肺疾病加重患者中，欧洲和英国的指南认可氧目标饱和度为88％–92％，如果二氧化碳水平正常，则应调整为94％–98％。我们评估了入院血氧饱和度水平和基线二氧化碳对住院病人死亡率的影响。方法从前瞻性呼吸困难，嗜酸性粒细胞减少，合并，酸血症和心房颤动（DECAF）衍生研究（2008年12月至2010年6月）和混合方法DECAF验证研究（2012年1月至2014年5月）中识别患者。在英国的六家医院中，在2645例COPD恶化患者中，有1027例在入院时接受补充氧气。所有患者都有COPD和阻塞性肺功能测定的临床病史。这些患者分为以下几类：入院氧饱和度为87％或更低，88％–92％，93％–96％或97％–100％。计算每组的住院死亡率，并表示为OR。DECAF得分和国家早期预警得分2（不包括血氧饱和度）用于二元logistic回归分析以调整基线风险。结果COPD患者接受补充氧气时，氧饱和度高于92％会导致更高的死亡率和不良的剂量反应。与88％–92％组相比，93％–96％和97％–100％组的调整后死亡风险（OR）为1.98（95％CI 1.09至3.60，p = 0.025）和2.97（95 ％CI 1.58至5.58，p = 0.001）。在患有高碳酸血症的亚组中，死亡率信号在93％–96％和97％–100％组中均保持显着水平。结论在氧饱和度为88％–92％的患者中，住院死亡率最低。即使氧饱和度适度升高超过此范围（93％–96％），也会增加死亡风险。高碳酸血症和高碳酸血症患者的死亡率趋势相似。这表明基于二氧化碳水平设置不同目标饱和度的做法是不合理的。以目标饱和度为88％–92％的所有COPD患者进行治疗将简化处方并应改善结局。试用注册号UKCRN ID 14214。以目标饱和度为88％–92％的所有COPD患者进行治疗将简化处方并应改善结局。试用注册号UKCRN ID 14214。以目标饱和度为88％–92％的所有COPD患者进行治疗将简化处方并应改善结局。试用注册号UKCRN ID 14214。

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Oxygen therapy and inpatient mortality in COPD exacerbation

Background In hospitalised patients with exacerbation of Chronic Obstructive Pulmonary Disease, European and British guidelines endorse oxygen target saturations of 88%–92%, with adjustment to 94%–98% if carbon dioxide levels are normal. We assessed the impact of admission oxygen saturation level and baseline carbon dioxide on inpatient mortality. Methods Patients were identified from the prospective Dyspnoea, Eosinopenia, Consolidation, Acidaemia and Atrial Fibrillation (DECAF) derivation study (December 2008–June 2010) and the mixed methods DECAF validation study (January 2012 to May 2014). In six UK hospitals, of 2645 patients with COPD exacerbation, 1027 patients were in receipt of supplemental oxygen at admission. All had a clinical history of COPD and obstructive spirometry. These patients were subdivided into the following groups: admission oxygen saturations of 87% or less, 88%–92%, 93%–96% or 97%–100%. Inpatient mortality was calculated for each group and expressed as ORs. The DECAF score and National Early Warning Score 2 (excluding oxygen saturation) were used in binary logistic regression to adjust for baseline risk. Results In patients with COPD receiving supplemental oxygen, oxygen saturations above 92% were associated with higher mortality and an adverse dose–response. Compared with the 88%–92% group, the adjusted risk of death (OR) in the 93%–96% and 97%–100% groups was 1.98 (95% CI 1.09 to 3.60, p=0.025) and 2.97 (95% CI 1.58 to 5.58, p=0.001). In the subgroup with normocapnia, the mortality signal remained significant in both the 93%–96% and 97%–100% groups. Conclusions Inpatient mortality was lowest in those with oxygen saturations of 88%–92%. Even modest elevations in oxygen saturations above this range (93%–96%) were associated with an increased risk of death. A similar mortality trend was seen in both patients with hypercapnia and normocapnia. This shows that the practice of setting different target saturations based on carbon dioxide levels is not justified. Treating all patients with COPD with target saturations of 88%–92% will simplify prescribing and should improve outcome. Trial registration number UKCRN ID 14214.

更新日期：2021-02-22

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