RT info:eu-repo/semantics/article
T1 Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality
A1 Martín Fernández, Marta
A1 Heredia Rodríguez, María
A1 González Jiménez, Irene
A1 Lorenzo López, Mario
A1 Gómez Pesquera, Estefanía
A1 Poves Álvarez, Rodrigo
A1 Álvarez, F. Javier
A1 Jorge Monjas, Pablo
A1 Beltrán-DeHeredia, Juan
A1 Gutiérrez Abejón, Eduardo
A1 Herrera Gómez, Francisco Magno
A1 Guzzo, Gabriella
A1 Gómez Sánchez, Esther
A1 Tamayo Velasco, Álvaro
A1 Aller de la Fuente, Rocío
A1 Pelosi, Paolo
A1 Villar, Jesús
A1 Tamayo Gómez, Eduardo
AB Background: Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no studies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO2) reduces the rate of surgical-wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO2 is associated with risk of death in adult patients with sepsis/septic shock after major surgery.Methods: We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO2 > 100 mmHg (n = 216), or PaO2 ≤ 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS-3 criteria maintained during 48 h. Primary end-point was 90-day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation.Results: In patients with PaO2 ≤ 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days, p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90-day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90-day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39-0.95, p = 0.029), independent of age, chronic renal failure, procalcitonin levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded.Conclusions: Oxygenation with a PaO2 above 100 mmHg was independently associated with lower 90-day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO2 in postsurgical patients with severe infections.
YR 2022
FD 2022
LK https://uvadoc.uva.es/handle/10324/64643
UL https://uvadoc.uva.es/handle/10324/64643
LA spa
NO Crit Care. 2022 Jan 10;26(1):4
NO Producción Científica
DS UVaDOC
RD 24-nov-2024