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. 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. 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. 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.

中文翻译：

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术后败血症/败血性休克患者的高氧血症与死亡率降低相关

尽管人们对限制 ICU 患者氧气暴露的治疗策略越来越感兴趣，但没有研究比较脓毒症/感染性休克术后患者的保守吸氧与标准吸氧，尽管有迹象表明保守吸氧可能会改善预后。事实证明，高动脉血氧分压 (PaO2) 可以降低大手术患者的手术伤口感染率和死亡率。本研究的目的是探讨 PaO2 是否与脓毒症/脓毒性休克成年患者大手术后的死亡风险相关。我们对一项前瞻性观察性研究进行了二次分析，该研究涉及 454 名接受大手术并入住单一 ICU 的患者。根据脓毒症/感染性休克发作当天的 SEPSIS-3 标准，将患者分为两组，无论他们是否患有高氧血症，定义为 PaO2 > 100 mmHg (n = 216)，或 PaO2 ≤ 100 mmHg (n = 238)。 48小时。主要终点是脓毒症诊断后 90 天的死亡率。次要终点是 ICU 住院时间和拔管时间。在 PaO2 ≤ 100 mmHg 的患者中，我们发现机械通气时间延长（2 [8] 天 vs. 1 [4] 天，p < 0.001），ICU 住院时间较长（8 [13] 天 vs. 5 [9] 天，p < 0.001） ），SOFA 评分评估的器官功能障碍较高（9 [3] vs. 7 [5]，p < 0.001），感染性休克患病率较高（200/238，84.0% vs 145/216）67.1%，p < 0.001 ）和更高的 90 天死亡率（37.0% [88] vs. 25.5% [55]，p = 0.008）。在多变量分析中，高氧血症与较高的 90 天生存概率相关（OR 0.61，95%CI：0.39-0.95，p = 0.029），与年龄、慢性肾功能衰竭、降钙素原水平和 APACHE II 评分 > 19 无关。当纳入研究时患有严重低氧血症的患者被排除时，这些发现得到了证实。PaO2 高于 100 mmHg 的氧合与重症术后脓毒症/感染性休克患者较低的 90 天死亡率、较短的 ICU 住院时间和插管时间独立相关。我们的研究结果为设计临床试验开辟了新的途径，以评估术后严重感染患者的 PaO2 界限。