Again, the results suggested that higher use of oxygen caused harm, but the single-center design and the stopping of the trial after an unplanned interim analysis hamper the interpretation. The other larger trial done in ICU patients, the OXYGEN-ICU trial, included 480 adult ICU patients expected to stay at least 72 h, among whom 40% had documented infection at baseline.
The implication being harmful effects of oxygen may be exaggerated in sepsis patients with evidence of cellular and metabolic abnormalities, likely to be mediated by reactive oxygen species, in the context of impaired mitochondrial function and lower antioxidant concentrations seen in sepsis. A post hoc analysis of Hyper2S-trial highlighted potential harm only in patients meeting the sepsis-3 defined septic shock, which is hypotension requiring vasopressor therapy and raised lactate concentrations. The results of the Hyper2S trial did support the notion of harm from more liberal use of oxygen as observed in observational studies in general ICU patients and in those with sepsis. While this caused some concern, the use of FiO 2 at 1.0 in clinical care of patients with sepsis appeared to be quite rare the baseline FiO 2 in two sepsis trials combined ( n = 1770) was reported to be 0.51 (inter-quartile range 0.40–0.70). The incidence of serious adverse events, including atelectasis and intensive care unit-acquired weakness, appeared to be higher in the hyperoxia vs. The primary outcome, 28-day mortality, had occurred in 43% in the hyperoxia group vs. The trial was stopped prematurely for safety reasons when 442 of the planned 800 patients had been enrolled. an FiO 2 targeting an oxygen saturation of 88–95% (normoxia) during the first 24 h. This two-by-two factorial, multicentre, randomised trial allocated mechanically ventilated patients with septic shock to an FiO 2 at 1.0 (hyperoxia) vs. To our knowledge, at least one randomised trial has been conducted on oxygen therapy in sepsis, the Hyper2S-trial.
0 kommentar(er)
