Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the L arge observational study to UN derstand the Gl obal impact of S evere A cute respiratory F ailur E (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO 2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO 2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO 2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO 2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO 2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO 2 . Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO 2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO 2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO 2 55–100 mmHg) patients ( P = 0.47). Conclusions Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

中文翻译：

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早期急性呼吸窘迫综合征中的高氧血症和过量氧气使用：来自 LUNG SAFE 研究的见解

背景 对急性呼吸窘迫综合征 (ARDS) 患者中不必要的氧气使用的普遍性和影响存在担忧。我们在参加大型观察性研究的 ARDS 患者中检查了这个问题，以了解严重急性呼吸衰竭 (LUNG SAFE) 研究对全球的影响。方法 在这项对 LUNG SAFE 研究的二次分析中，我们希望确定与早期 ARDS 患者第 1 天高氧血症、持续高氧血症和过度吸氧相关的患病率和结果。在急性低氧性呼吸衰竭的第 1 天和第 2 天满足 ARDS 标准的患者根据第 1 天是否存在高氧血症（PaO 2 > 100 mmHg）、持续（即存在于第 1 天和第 2 天）高氧血症、或过度吸氧（高氧血症期间 FIO 2 ≥ 0.60）。结果 2005 名符合纳入标准的患者中，131 名（6.5%）低氧血症（PaO 2 < 55 mmHg），607 名（30%）第 1 天高氧血症，250 名（12%）持续高氧血症。607 名高氧血症患者中有 400 名 (66%) 使用过量 FIO 2。从 ARDS 的第 1 天到第 2 天，过量的 FIO 2 使用量减少，大多数高氧血症患者在第 2 天接受的 FIO 2 相对较低。多变量分析发现第 1 天高氧血症、持续高氧血症或过量使用 FIO 2 与不良临床结果之间没有独立关系。过量使用 FIO 2 的患者死亡率为 42%，而在血氧正常 (PaO 2 55–100 mmHg) 患者的倾向匹配样本中死亡率为 39% ( P = 0.47)。结论 高氧血症和过量吸氧在早期 ARDS 中都很普遍，但最常见的是非持续性的。在该队列中，未发现高氧血症或过度吸氧与患者预后之间存在关联。试验注册 LUNG-SAFE 在 ClinicalTrials.gov 注册，NCT02010073