Table_4_Conservative oxygen therapy in critically ill and perioperative period of patients with sepsis-associated encephalopathy.docx

ObjectivesSepsis-associated encephalopathy (SAE) patients in the intensive care unit (ICU) and perioperative period are administrated supplemental oxygen. However, the correlation between oxygenation status with SAE and the target for oxygen therapy remains unclear. This study aimed to examine the relationship between oxygen therapy and SAE patients.
MethodsPatients diagnosed with sepsis 3.0 in the intensive care unit (ICU) were enrolled. The data were collected from the Medical Information Mart for Intensive Care IV (MIMIC IV) database and the eICU Collaborative Research Database (eICU-CRD) database. The generalized additive models were adopted to estimate the oxygen therapy targets in SAE patients. The results were confirmed by multivariate Logistic, propensity score analysis, inversion probability-weighting, doubly robust model, and multivariate COX analyses. Survival was analyzed by the Kaplan-Meier method.
ResultsA total of 10055 patients from eICU-CRD and 1685 from MIMIC IV were included. The incidence of SAE patients was 58.43%. The range of PaO2 (97-339) mmHg, PaO2/FiO2 (189-619), and SPO2≥93% may reduce the incidence of SAE, which were verified by multivariable Logistic regression, propensity score analysis, inversion probability-weighting, and doubly robust model estimation in MIMIC IV database and eICU database. The range of PaO2/FiO2 (189-619) and SPO2≥93% may reduce the hospital mortality of SAE were verified by multivariable COX regression.
ConclusionsSAE patients in ICU, including perioperative period, require conservative oxygen therapy. We should maintain SPO2≥93%, PaO2 (97-339) mmHg and PaO2/FiO2 (189-619) in SAE patients.

研究目的：重症监护病房（Intensive Care Unit, ICU）及围手术期的脓毒症相关性脑病（Sepsis-associated encephalopathy, SAE）患者均需接受补充氧疗，但目前氧合状态与脓毒症相关性脑病的关联，以及氧疗目标仍不明确。本研究旨在探讨氧疗与脓毒症相关性脑病患者的相关性。研究方法：本研究纳入确诊脓毒症3.0的重症监护病房患者，数据来源于重症监护医疗信息集市IV（Medical Information Mart for Intensive Care IV, MIMIC IV）数据库与eICU协作研究数据库（eICU Collaborative Research Database, eICU-CRD）。采用广义加性模型估算脓毒症相关性脑病患者的氧疗目标，并通过多因素Logistic回归、倾向得分分析、逆概率加权法、双稳健模型以及多因素COX分析对结果进行验证。采用Kaplan-Meier法进行生存分析。研究结果：本研究共纳入eICU-CRD数据库的10055例患者，以及MIMIC IV数据库的1685例患者。脓毒症相关性脑病的总发生率为58.43%。在MIMIC IV数据库与eICU数据库中，经多因素Logistic回归、倾向得分分析、逆概率加权法及双稳健模型估算验证，动脉血氧分压（PaO2）处于97~339 mmHg、动脉血氧分压/吸入氧浓度分数（PaO2/FiO2）处于189~619，以及脉搏血氧饱和度（SPO2）≥93%的范围，或可降低脓毒症相关性脑病的发生率。经多因素COX回归分析验证，PaO2/FiO2处于189~619以及SPO2≥93%的范围，或可降低脓毒症相关性脑病患者的住院病死率。研究结论：重症监护病房（包括围手术期）的脓毒症相关性脑病患者需采取保守氧疗策略，临床应将此类患者的SPO2维持在≥93%，PaO2维持在97~339 mmHg，PaO2/FiO2维持在189~619。