High levels of PO2 vs. Traditional PO2 for ventilation of ARDS patients
Aya Hisham Moussa Ahmad;
Abstract
Abstract Rationale: There are no randomized controlled trials (RCTs) comparing different oxygenation targets in ventilated ARDS patients.
Objectives: to study the effect of a conservative oxygenation strategy (PO2 goals: 55-80 mmHg) vs. a more liberal one (PO2 goals: 80-100mmHg), in the management of ARDS patients and the detection of potential oxygen toxicity and morbidity of other vital organs, e.g. the kidneys (the subsequent occurrence of AKI as defined by the RIFLE classification.)
Methods: A total of 100 ICU patients subjected to mechanical ventilation for management of ARDS, were randomly allocated to either a conservative oxygenation strategy with target PO2 of 55-80 mmHg, (n=50) or a liberal oxygenation strategy with target PO2 of 80- 100mmHg, (n=50).
Measurements and Main Results: Serial serum Creatinine measurements showed higher readings in the liberal group starting day 2, which was statistically significant (P< 0.001), and continuing till day 28 (p= 0.32), higher readings of plasma Cystatin C levels starting day 3 in the liberal group, which was statistically significant (p= 0.01), till day 28, (p= 0.047), There was no significant difference between the two groups in terms of arrhythmias (defined as non sustained atrial and ventricular tachyarrhythmias) (p= 0.729), infection (defined as positive bacterial culture in sputum, urine, or blood) (p= 0.28); acquired RRT (defined as that started 24 hr after enrolment) in the ICU, (p= 0.821); and the use of antidelirium drugs (haloperidol, olanzapine, quetiapine, and dexmedetomidine), (p= 0.386), and As regards SOFA score and mortality at Day 28, lower incidences were recorded in the conservative group, which was statistically significant, (p= 0.095) for the SOFA score, and p= 0.036 for mortality at 28 days.
Conclusions: Our study supports the feasibility of a conservative oxygenation strategy in patients receiving IMV. Larger RCTs of this intervention appear justified.
Key words: Mechanical ventilation, ARDS, cystatin C, AKI and oxygen toxicity.
Objectives: to study the effect of a conservative oxygenation strategy (PO2 goals: 55-80 mmHg) vs. a more liberal one (PO2 goals: 80-100mmHg), in the management of ARDS patients and the detection of potential oxygen toxicity and morbidity of other vital organs, e.g. the kidneys (the subsequent occurrence of AKI as defined by the RIFLE classification.)
Methods: A total of 100 ICU patients subjected to mechanical ventilation for management of ARDS, were randomly allocated to either a conservative oxygenation strategy with target PO2 of 55-80 mmHg, (n=50) or a liberal oxygenation strategy with target PO2 of 80- 100mmHg, (n=50).
Measurements and Main Results: Serial serum Creatinine measurements showed higher readings in the liberal group starting day 2, which was statistically significant (P< 0.001), and continuing till day 28 (p= 0.32), higher readings of plasma Cystatin C levels starting day 3 in the liberal group, which was statistically significant (p= 0.01), till day 28, (p= 0.047), There was no significant difference between the two groups in terms of arrhythmias (defined as non sustained atrial and ventricular tachyarrhythmias) (p= 0.729), infection (defined as positive bacterial culture in sputum, urine, or blood) (p= 0.28); acquired RRT (defined as that started 24 hr after enrolment) in the ICU, (p= 0.821); and the use of antidelirium drugs (haloperidol, olanzapine, quetiapine, and dexmedetomidine), (p= 0.386), and As regards SOFA score and mortality at Day 28, lower incidences were recorded in the conservative group, which was statistically significant, (p= 0.095) for the SOFA score, and p= 0.036 for mortality at 28 days.
Conclusions: Our study supports the feasibility of a conservative oxygenation strategy in patients receiving IMV. Larger RCTs of this intervention appear justified.
Key words: Mechanical ventilation, ARDS, cystatin C, AKI and oxygen toxicity.
Other data
| Title | High levels of PO2 vs. Traditional PO2 for ventilation of ARDS patients | Other Titles | مقارنه المستويات المرتفعة من الضغط الجزئي للاكسجين بالمستويات التقليدية في التنفس الصناعي لمرضي متلازمة الضائقة التنفسية للكبار | Authors | Aya Hisham Moussa Ahmad | Issue Date | 2017 |
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