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Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
C. Robba, R. Badenes, D. Battaglini, L. Ball, F. Sanfilippo, I. Brunetti, JC. Jakobsen, G. Lilja, H. Friberg, PD. Wendel-Garcia, PJ. Young, G. Eastwood, MS. Chew, J. Unden, M. Thomas, M. Joannidis, A. Nichol, A. Lundin, J. Hollenberg, N. Hammond,...
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články, randomizované kontrolované studie
NLK
BioMedCentral
od 1997-04-01
BioMedCentral Open Access
od 1997
Directory of Open Access Journals
od 1998
Free Medical Journals
od 1997
PubMed Central
od 1997
Europe PubMed Central
od 1997
ProQuest Central
od 2015-01-01
Open Access Digital Library
od 1997-01-01
Open Access Digital Library
od 1997-08-01
Open Access Digital Library
od 1998-01-01
Medline Complete (EBSCOhost)
od 2011-02-01
Health & Medicine (ProQuest)
od 2015-01-01
ROAD: Directory of Open Access Scholarly Resources
od 1997
Springer Nature OA/Free Journals
od 1997-04-01
- MeSH
- hypotermie * komplikace MeSH
- hypoxie komplikace MeSH
- kyslík MeSH
- lidé středního věku MeSH
- lidé MeSH
- parciální tlak MeSH
- senioři MeSH
- zástava srdce mimo nemocnici * komplikace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients' outcome. METHODS: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. RESULTS: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). CONCLUSIONS: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. TRIAL REGISTRATION: clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
Department of Anaesthesia and Intensive Care A O U Policlinico San Marco Catania Italy
Department of Clinical Medicine Aarhus University Aarhus Denmark
Department of Clinical Medicine Anaesthesiology and Intensive Care Lund University Lund Sweden
Department of Clinical Sciences Lund Anesthesia and Intensive Care Lund University Lund Sweden
Department of Clinical Sciences Malmö Lund University Malmö Sweden
Department of Critical Care University of Melbourne Parkville VIC Australia
Department of Intensive Care Austin Hospital Melbourne Australia
Department of Intensive Care Medicine Aarhus University Hospital Aarhus Denmark
Department of Intensive Care Medicine Université Libre de Bruxelles Hopital Erasme Brussels Belgium
Department of Medicine University of Barcelona Barcelona Spain
Department of Operation and Intensive Care Hallands Hospital Halmstad Lund University Halland Sweden
Department of Surgery University of Valencia Valencia Spain
Intensive Care Unit St George Hospital Sydney Australia
Intensive Care Unit Wellington Regional Hospital Wellington New Zealand
Medical Research Institute of New Zealand Private Bag 7902 Wellington 6242 New Zealand
Monash University Melbourne VIC Australia
University Hospitals Bristol NHS Foundation Trust Bristol UK
Citace poskytuje Crossref.org
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- $a Robba, Chiara $u Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. kiarobba@gmail.com $u Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy. kiarobba@gmail.com $1 https://orcid.org/0000000316283845
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- $a Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial / $c C. Robba, R. Badenes, D. Battaglini, L. Ball, F. Sanfilippo, I. Brunetti, JC. Jakobsen, G. Lilja, H. Friberg, PD. Wendel-Garcia, PJ. Young, G. Eastwood, MS. Chew, J. Unden, M. Thomas, M. Joannidis, A. Nichol, A. Lundin, J. Hollenberg, N. Hammond, M. Saxena, A. Martin, M. Solar, FS. Taccone, J. Dankiewicz, N. Nielsen, AM. Grejs, F. Ebner, P. Pelosi, TTM2 Trial collaborators
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- $a BACKGROUND: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients' outcome. METHODS: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. RESULTS: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). CONCLUSIONS: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. TRIAL REGISTRATION: clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
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