Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation.

Autor: Burrell A; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia., Bailey MJ; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Bellomo R; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia.; Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, VIC, Australia., Buscher H; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia., Eastwood G; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia., Forrest P; Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Fraser JF; Institute of Molecular Bioscience, The University of Queensland, Herston, QLD, Australia.; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia., Fulcher B; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Gattas D; Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Higgins AM; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; The George Institute for Global Health, Newtown, NSW, Australia., Hodgson CL; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.; Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia., Litton E; Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia.; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation, Melbourne, VIC, Australia., Martin EL; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia., Nair P; The George Institute for Global Health, Newtown, NSW, Australia.; Intensive Care Unit, St Vincent's Hospital, Darlinghurst, NSW, Australia.; University of New South Wales, Sydney, NSW, Australia., Ng SJ; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Orford N; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.; School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, Australia., Ottosen K; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Paul E; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Pellegrino V; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia., Reid L; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Shekar K; Institute of Molecular Bioscience, The University of Queensland, Herston, QLD, Australia.; Adult Intensive Care Unit, The Prince Charles Hospital, Chermside, QLD, Australia., Totaro RJ; Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Trapani T; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Udy A; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia., Ziegenfuss M; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.; Adult Intensive Care Unit, The Prince Charles Hospital, Chermside, QLD, Australia., Pilcher D; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. david.pilcher@monash.edu.; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia. david.pilcher@monash.edu.; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation, Melbourne, VIC, Australia. david.pilcher@monash.edu.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2024 Sep; Vol. 50 (9), pp. 1470-1483. Date of Electronic Publication: 2024 Aug 20.
DOI: 10.1007/s00134-024-07564-8
Abstrakt: Purpose: Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets may also lead to harmful episodes of hypoxaemia.
Methods: In this registry-embedded, multicentre trial, we randomly assigned adult patients receiving VA-ECMO in an intensive care unit (ICU) to either a conservative (target SaO 2 92-96%) or to a liberal oxygen strategy (target SaO 2 97-100%) through controlled oxygen administration via the ventilator and ECMO gas blender. The primary outcome was the number of ICU-free days to day 28. Secondary outcomes included ICU-free days to day 60, mortality, ECMO and ventilation duration, ICU and hospital lengths of stay, and functional outcomes at 6 months.
Results: From September 2019 through June 2023, 934 patients who received VA-ECMO were reported to the EXCEL registry, of whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) were recruited. We randomised 149 to a conservative and 151 to a liberal oxygen strategy. The median number of ICU-free days to day 28 was similar in both groups (conservative: 0 days [interquartile range (IQR) 0-13.7] versus liberal: 0 days [IQR 0-13.7], median treatment effect: 0 days [95% confidence interval (CI) - 3.1 to 3.1]). Mortality at day 28 (59/159 [39.6%] vs 59/151 [39.1%]) and at day 60 (64/149 [43%] vs 62/151 [41.1%] were similar in conservative and liberal groups, as were all other secondary outcomes and adverse events. The conservative group experienced 44 (29.5%) major protocol deviations compared to 2 (1.3%) in the liberal oxygen group (P < 0.001).
Conclusions: In adults receiving VA-ECMO in ICU, a conservative compared to a liberal oxygen strategy, did not affect the number of ICU-free days to day 28.
(© 2024. The Author(s).)
Databáze: MEDLINE
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