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
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, 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 20-may-2024