Oxygen Targets for Mechanically Ventilated Adults with Sepsis: Secondary Analysis of the PILOT Trial.

IF 3 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of Intensive Care Medicine Pub Date : 2025-01-09 DOI:10.1177/08850666241299378

Jack C Shapiro, Jonathan D Casey, Edward T Qian, Kevin P Seitz, Li Wang, Bradley D Lloyd, Joanna L Stollings, Robert E Freundlich, Wesley H Self, Todd W Rice, Jonathan P Wanderer, Matthew W Semler

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Abstract

Background: Patients with sepsis frequently require invasive mechanical ventilation. How oxygenation during mechanical ventilation affects clinical outcomes for patients with sepsis remains uncertain.

Research question: To evaluate the effects of different oxygen saturation targets on clinical outcomes for patients with sepsis receiving mechanical ventilation.

Study design and methods: We performed a secondary analysis of the Pragmatic Investigation of optimaL Oxygen Targets (PILOT) trial dataset among patients who met criteria for sepsis by the Sepsis-3 definition at the time of enrollment. We compared patients randomized to a lower oxygen saturation target (90%; range, 88-92%), an intermediate target (94%; range, 92-96%), and a higher target (98%; range, 96-100%) with regard to the outcomes of 28-day in-hospital mortality and ventilator-free days to study day 28.

Results: Of 2541 patients in the PILOT dataset, 805 patients with sepsis were included in the current analysis. In-hospital mortality by day 28 did not differ significantly between the lower target group (48%; 95% confidence interval [CI], 42% to 54%), the intermediate target group (50%; 95% CI, 43% to 56%), and the higher target group (51%; 95% CI, 45% to 56%) (P = 0.83). The number of ventilator-free days to day 28 did not significantly differ between the trial groups, with a mean of 9.9 (standard deviation [SD], 11.8) in the lower oxygen saturation target group, 9.5 (SD, 11.2) in the intermediate group, and 9.4 (SD, 11.4) in the higher group (P = 0.65).

Interpretation: Among mechanically ventilated patients with sepsis in a large, randomized trial, the incidence of 28-day in-hospital mortality was not statistically significantly different between the use of a lower, intermediate, or higher oxygen target. However, the confidence intervals included treatment effects that would be clinically meaningfully and further randomized trials of oxygen targets in sepsis are required.

Referenced trial name: Pragmatic Investigation of optimaL Oxygen Targets Trial (PILOT)ClinicalTrials.gov number NCT03537937URL: https://clinicaltrials.gov/study/NCT03537937.

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机械通气成人脓毒症患者的氧靶：PILOT试验的二次分析。

背景：脓毒症患者经常需要有创机械通气。机械通气期间的氧合如何影响脓毒症患者的临床结果仍不确定。研究问题：评价不同血氧饱和度指标对脓毒症机械通气患者临床结局的影响。研究设计和方法：我们对在入组时符合脓毒症-3定义的脓毒症标准的患者进行了最佳氧靶实用性调查（PILOT）试验数据集的二次分析。我们比较了随机分配到较低氧饱和度目标(90%；范围，88-92%)，中间目标(94%；范围，92-96%)，以及更高的目标(98%；范围，96% -100%)关于28天住院死亡率和研究第28天无呼吸机天数的结果。结果：在PILOT数据集中的2541例患者中，805例脓毒症患者被纳入当前的分析。第28天的住院死亡率在低目标组之间没有显著差异(48%；95%可信区间[CI]， 42% ~ 54%)，中间目标组(50%；95% CI， 43%至56%)，以及更高的目标群体(51%；95% CI, 45% ~ 56%) （P = 0.83）。各组无呼吸机天数至第28天无呼吸机天数无显著差异，低氧饱和度目标组平均9.9天（标准差[SD]， 11.8），中等氧饱和度目标组平均9.5天（SD, 11.2），高氧饱和度目标组平均9.4天（SD, 11.4）（P = 0.65）。解释：在一项大型随机试验中，在机械通气的脓毒症患者中，使用较低、中等或较高氧靶的28天住院死亡率发生率无统计学显著差异。然而，置信区间包括具有临床意义的治疗效果，需要进一步的脓毒症氧靶点随机试验。临床试验网站：ClinicalTrials.gov编号NCT03537937URL: https://clinicaltrials.gov/study/NCT03537937。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Intensive Care Medicine CRITICAL CARE MEDICINE-

CiteScore

7.60

自引率

3.20%

发文量

107

期刊介绍： Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.