Exposure to high concentrations of inspired oxygen does not worsen lung injury after cardiac arrest

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• 作者：Jonathan Elmer (1) (2) (3)
  Bo Wang (3)
  Samer Melhem (4)
  Raghevesh Pullalarevu (5)
  Nishit Vaghasia (5)
  Jaya Buddineni (2)
  Bedda L Rosario (6)
  Ankur A Doshi (3)
  Clifton W Callaway (1) (3)
  Cameron Dezfulian (1) (2) (7)
  on behalf of the University of Pittsburgh Post-Cardiac Arrest Service (PCAS)
  
  1. Safar Center for Resuscitation Research ; University of Pittsburgh School of Medicine ; 100 Hill Building ; 3434 Fifth Avenue ; Pittsburgh ; PA ; 15260 ; USA
  2. Department of Critical Care Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh ; USA
  3. Department of Emergency Medicine ; University of Pittsburgh School of Medicine ; Pittsburgh ; USA
  4. Department of Anesthesiology ; New York University Langone Medical Center ; Pittsburgh ; USA
  5. Department of Internal Medicine ; University of Pittsburgh Medical Center Mercy Hospital ; Pittsburgh ; USA
  6. Department of Epidemiology ; Graduate School of Public Health ; University of Pittsburgh ; Pittsburgh ; USA
  7. Vascular Medicine Institute ; University of Pittsburgh School of Medicine ; Pittsburgh ; USA
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：627 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Post-cardiac arrest patients are often exposed to 100% oxygen during cardiopulmonary resuscitation and the early post-arrest period. It is unclear whether this contributes to development of pulmonary dysfunction or other patient outcomes. Methods We performed a retrospective cohort study including post-arrest patients who survived and were mechanically ventilated at least 24聽hours after return of spontaneous circulation. Our primary exposure of interest was inspired oxygen, which we operationalized by calculating the area under the curve of the fraction of inspired oxygen (FiO2AUC) for each patient over 24聽hours. We collected baseline demographic, cardiovascular, pulmonary and cardiac arrest-specific covariates. Our main outcomes were change in the respiratory subscale of the Sequential Organ Failure Assessment score (SOFA-R) and change in dynamic pulmonary compliance from baseline to 48聽hours. Secondary outcomes were survival to hospital discharge and Cerebral Performance Category at discharge. Results We included 170 patients. The first partial pressure of arterial oxygen (PaO2):FiO2 ratio was 241鈥壜扁€?37, and 85% of patients had pulmonary failure and 55% had cardiovascular failure at presentation. Higher FiO2AUC was not associated with change in SOFA-R score or dynamic pulmonary compliance from baseline to 48聽hours. However, higher FiO2AUC was associated with decreased survival to hospital discharge and worse neurological outcomes. This was driven by a 50% decrease in survival in the highest quartile of FiO2AUC compared to other quartiles (odds ratio for survival in the highest quartile compared to the lowest three quartiles 0.32 (95% confidence interval 0.13 to 0.79), P鈥?鈥?.003). Conclusions Higher exposure to inhaled oxygen in the first 24聽hours after cardiac arrest was not associated with deterioration in gas exchange or pulmonary compliance after cardiac arrest, but was associated with decreased survival and worse neurological outcomes.