Conservative oxygen therapy in critically ill and perioperative period of patients with sepsis-associated encephalopathy

Yun Li; Lina Zhao; Yang Yu; Kai Zhang; Yi Jiang; Zhiwei Wang; Keliang Xie; Yonghao Yu

doi:10.3389/fimmu.2022.1035298

Conservative oxygen therapy in critically ill and perioperative period of patients with sepsis-associated encephalopathy

Front Immunol. 2022 Oct 19:13:1035298. doi: 10.3389/fimmu.2022.1035298. eCollection 2022.

Authors

Yun Li^{1

2}, Lina Zhao³, Yang Yu^{1

2}, Kai Zhang^{1

2}, Yi Jiang^{1

2}, Zhiwei Wang³, Keliang Xie^{1

2

3}, Yonghao Yu^{1

2}

Affiliations

¹ Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China.
² Tianjin Research Institute of Anesthesiology, Tianjin, China.
³ Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.

Abstract

Objectives: Sepsis-associated encephalopathy (SAE) patients in the intensive care unit (ICU) and perioperative period are administrated supplemental oxygen. However, the correlation between oxygenation status with SAE and the target for oxygen therapy remains unclear. This study aimed to examine the relationship between oxygen therapy and SAE patients.

Methods: Patients diagnosed with sepsis 3.0 in the intensive care unit (ICU) were enrolled. The data were collected from the Medical Information Mart for Intensive Care IV (MIMIC IV) database and the eICU Collaborative Research Database (eICU-CRD) database. The generalized additive models were adopted to estimate the oxygen therapy targets in SAE patients. The results were confirmed by multivariate Logistic, propensity score analysis, inversion probability-weighting, doubly robust model, and multivariate COX analyses. Survival was analyzed by the Kaplan-Meier method.

Results: A total of 10055 patients from eICU-CRD and 1685 from MIMIC IV were included. The incidence of SAE patients was 58.43%. The range of PaO₂ (97-339) mmHg, PaO₂/FiO₂ (189-619), and S_PO₂≥93% may reduce the incidence of SAE, which were verified by multivariable Logistic regression, propensity score analysis, inversion probability-weighting, and doubly robust model estimation in MIMIC IV database and eICU database. The range of PaO₂/FiO₂ (189-619) and S_PO₂≥93% may reduce the hospital mortality of SAE were verified by multivariable COX regression.

Conclusions: SAE patients in ICU, including perioperative period, require conservative oxygen therapy. We should maintain S_PO₂≥93%, PaO₂ (97-339) mmHg and PaO₂/FiO₂ (189-619) in SAE patients.

Keywords: incidence; mortality; oxygen saturation; sepsis; sepsis-associated encephalopathy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Critical Illness
Humans
Oxygen
Oxygen Inhalation Therapy / adverse effects
Oxygen Inhalation Therapy / methods
Perioperative Period
Sepsis-Associated Encephalopathy* / etiology
Sepsis-Associated Encephalopathy* / therapy

Substances

Oxygen