发表于（NEJM, IF:70.67）
Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome
- Barrot Loic,Asfar Pierre,Mauny Frederic et al. Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome.[J] .N. Engl. J. Med., 2020, 382: 999-1008.
BACKGROUND 背景
In patients with acute respiratory distress syndrome (ARDS), the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network recommends a target partial pressure of arterial oxygen (Pao2) between 55 and 80 mm Hg. Prospective validation of this range in patients with ARDS is lacking. We hypothesized that targeting the lower limit of this range would improve outcomes in patients with ARDS.
在急性呼吸窘迫综合征(ARDS)患者中，国家心、肺和血液研究所ARDS临床试验网络建议动脉血氧分压(PaO2)的目标在55至80 mmHg之间。对ARDS患者该范围的前瞻性验证尚缺。我们假设，将目标锁定在这个范围的下限将改善ARDS患者的预后。
METHODS 方法
In this multicenter, randomized trial, we assigned patients with ARDS to receive either conservative oxygen therapy (target Pao2, 55 to 70 mm Hg; oxygen saturation as measured by pulse oximetry [Spo2], 88 to 92%) or liberal oxygen therapy (target Pao2, 90 to 105 mm Hg; Spo2, ≥96%) for 7 days. The same mechanical-ventilation strategies were used in both groups. The primary outcome was death from any cause at 28 days.
在这项多中心随机试验中，我们将急性呼吸窘迫综合征患者分为保守氧疗(目标PaO2，55~70 mmHg，SpO2, 88~92%)和自由氧疗(目标PaO2，90~105 mmHg，SpO2，≥96%)，治疗7天。两组采用相同的机械通气策略。主要结局是在28天内死于任何原因。
RESULTS 结果
After the enrollment of 205 patients, the trial was prematurely stopped by the data and safety monitoring board because of safety concerns and a low likelihood of a significant difference between the two groups in the primary outcome. Four pa- tients who did not meet the eligibility criteria were excluded. At day 28, a total of 34 of 99 patients (34.3%) in the conservative-oxygen group and 27 of 102 patients (26.5%) in the liberal-oxygen group had died (difference, 7.8 percentage points; 95% confidence interval [CI], −4.8 to 20.6). At day 90, 44.4% of the patients in the conservative-oxygen group and 30.4% of the patients in the liberal-oxygen group had died (difference, 14.0 percentage points; 95% CI, 0.7 to 27.2). Five mesenteric ischemic events occurred in the conservative-oxygen group.
在205名患者登记后，数据和安全监测委员会出于安全考虑和两组患者在主要结局上存在显著差异的低可能性，提前停止了试验。四名不符合资格标准的患者被排除在外。在第28天，保守氧气组99名患者中共有34名(34.3%)死亡，自由氧气组102名患者中27名(26.5%)死亡(差异，7.8个百分点；95%可信区间[CI]，-4.8～20.6)。在第90天，保守氧气组和自由氧气组分别有44.4%和30.4%的患者死亡(差异，14.0个百分点；95%可信区间[CI]，0.7~27.2)。保守氧疗组共发生5例肠系膜缺血事件。
CONCLUSIONS 结论
Among patients with ARDS, early exposure to a conservative-oxygenation strategy with a Pao2 between 55 and 70 mm Hg did not increase survival at 28 days. (Funded by the French Ministry of Health; LOCO2 ClinicalTrials.gov number, NCT02713451.)
在ARDS患者中，早期暴露于动脉血氧分压在55至70 mmHg之间的保守氧合策略并不能增加28天的存活率。(由法国卫生部资助；LOCO2 ClinicalTrials.gov编号，NCT02713451)
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