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Volume 13 Issue 1
Jan.  2022
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WANG Yang, CHEN Hao. The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(1): 89-95. DOI: 10.12290/xhyxzz.2021-0212
Citation: WANG Yang, CHEN Hao. The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(1): 89-95. DOI: 10.12290/xhyxzz.2021-0212
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The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients

  • 1.

    Pulmonary and Critical Care Medicine, First People's Hospital of Chongqing Liangjiang New Area, Chongqing 401121, China

  • 2.

    Pulmonary and Critical Care Medicine, Dianjiang People's Hospital, Chongqing 408300, China

Funds: 

Medical Scientific Research Project of Chongqing Health Commission 2022WSJK051

More Information
  • Corresponding author:

    CHEN Hao, E-mail: 1041863309@qq.com

  • Received Date: February 20, 2021
  • Accepted Date: May 19, 2021
  • Available Online: January 27, 2022
  • Issue Publish Date: January 29, 2022
    Graphical Abstract
    • Abstract
  •   Objective  To determine the association between pulse oximetry-derived oxygen saturation(SpO2) and all-cause in-hospital mortality of patients with pulmonary embolism during oxygen therapy.
      Methods  Clinical data of the patients with pulmonary embolism as the primary diagnosis in different American medical institutions from the eICU database during 2014 to 2015 were retrieved. Generalized additive model (GAM) was constructed and the graph was drawn to analyze the association between median SpO2 and all-cause in-hospital mortality. The lowest and smooth area of the curve was the optimal SpO2 range. Moreover, the mult- ivariate Cox regression model was applied to verify the association between SpO2 level during oxygen therapy and all-cause in-hospital mortality of patients with pulmonary embolism.
      Results  A total of 422 patients with pulmonary embolism that met the inclusion and exclusion criteria were enrolled. The median score of SpO2 was 97%(95%, 98%) during oxygen therapy.A total of 336 (79.6%) patients were discharged from the hospital and 86 (20.4%) patients died. The GAM indicated a U-shaped relationship between the median score of SpO2 and all-cause in-hospital mortality in patients with pulmonary embolism. In addition, the lowest mortality was observed when the SpO2 range was 96%-98%. Multivariable Cox regression analysis confirmed that the SpO2 level was independently associated with decreased mortality. Taking patients with median SpO2 rang of 96% to 98% as controls, the risk of all-cause in-hospital mortality was increased by 129.8% in patients with median SpO2 < 96% (HR=2.298, 95% CI: 1.268-4.163, P=0.006) and 77.3% in patients with median SpO2 > 98% (HR=1.773, 95% CI: 1.068-2.942, P=0.027).
      Conclusions  The relationship between SpO2 levels and all-cause in-hospital mortality followed a U-shaped curve in patients with pulmonary embolism. The risk of all-cause in-hospital mortality was lowest when SpO2 was between 96% to 98% during oxygen therapy, which may be the target range of oxygenation.
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    • References (33)
  • [1]
    Jiménez D, Bikdeli B, Barrios D, et al. Epidemiology, patterns of care and mortality for patients with hemodynamically unstable acute symptomatic pulmonary embolism[J]. Int J Cardiol, 2018, 269: 327-333. DOI: 10.1016/j.ijcard.2018.07.059
    [2]
    Turetz M, Sideris AT, Friedman OA, et al. Epidemiology, pathophysiology, and natural history of pulmonary embolism[J]. Semin Intervent Radiol, 2018, 35: 92-98. DOI: 10.1055/s-0038-1642036
    [3]
    Fernandes CJ, Luppino Assad AP, Alves-Jr JL, et al. Pulmonary Embolism and Gas Exchange[J]. Respiration, 2019, 98: 253-262. DOI: 10.1159/000501342
    [4]
    Larsen K, Coolen-Allou N, Masse L, et al. Detection of Pulmonary Embolism in Returning Travelers with Hypoxemic Pneumonia due to COVID-19 in Reunion Island[J]. Am J Trop Med Hyg, 2020, 103: 844-846. DOI: 10.4269/ajtmh.20-0597
    [5]
    Ray S, Qureshi SA, Stolagiewicz N, et al. An unusual case of persisting hypoxia in a patient with a thrombolysed pulmonary embolism[J]. Clin Med (Lond), 2020, 20: 593-596.
    [6]
    Han CH, Guan ZB, Zhang PX, et al. Oxidative stress induced necroptosis activation is involved in the pathogenesis of hyperoxic acute lung injury[J]. Biochem Biophys Res Commun, 2018, 495: 2178-2183. DOI: 10.1016/j.bbrc.2017.12.100
    [7]
    Asfar P, Schortgen F, Boisramé-Helms J, et al. Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial[J]. Lancet Respir Med, 2017, 5: 180-190. DOI: 10.1016/S2213-2600(17)30046-2
    [8]
    O'Halloran HM, Kwong K, Veldhoen RA, et al. Characterizing the Patients, Hospitals, and Data Quality of the eICU Collaborative Research Database[J]. Crit Care Med, 2020, 48: 1737-1743. DOI: 10.1097/CCM.0000000000004633
    [9]
    Louie A, Feiner JR, Bickler PE, et al. Four Types of Pulse Oximeters Accurately Detect Hypoxia during Low Perfusion and Motion[J]. Anesthesiology, 2018, 128(3): 520-530. DOI: 10.1097/ALN.0000000000002002
    [10]
    邹琳琳, 胡忠, 王进, 等. 基于MIMIC-Ⅲ公共数据库评价六种重症评分对呼吸重症监护患者ICU死亡风险的预测价值[J]. 中国呼吸与危重监护杂志, 2021, 20: 170-176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGHW202103005.htm

    Zou LL, Hu Z, Wang J, et al. Evaluation the predictive values of six critical illness scores for ICU mortality in respiratory intensive care based on MIMIC-Ⅲ database[J]. Zhongguo Huxi Yu Weizhong Jianhu Zazhi, 2021, 20: 170-176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGHW202103005.htm
    [11]
    Zimmerman JE, Kramer AA, McNair DS, et al. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅳ: hospital mortality assessment for today's critically ill patients[J]. Crit Care Med, 2006, 34: 1297-1310. DOI: 10.1097/01.CCM.0000215112.84523.F0
    [12]
    Venetz C, Jiménez D, Mean M, et al. A comparison of the original and simplified Pulmonary Embolism Severity Index[J]. Thromb Haemost, 2011, 106: 423-428. DOI: 10.1160/TH11-04-0263
    [13]
    Zhang Z. Multiple imputation for time series data with Amelia package[J]. Ann Transl Med, 2016, 4: 56. DOI: 10.21037/atm.2016.10.30
    [14]
    张云权, 朱耀辉, 李存禄, 等. 广义相加模型在R软件中的实现[J]. 中国卫生统计, 2015, 32: 1073-1075. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201506053.htm

    Zhang YQ, Zhu YH, Li CL, et al. Operation of generalized additive model in R software[J]. Zhongguo Weisheng Tongji, 2015, 32: 1073-1075. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201506053.htm
    [15]
    Tusman G, Bohm SH, Suarez-Sipmann F. Advanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated Patients[J]. Anesth Analg, 2017, 124: 62-71. DOI: 10.1213/ANE.0000000000001283
    [16]
    Allardet-Servent J, Sicard G, Metz V, et al. Benefits and risks of oxygen therapy during acute medical illness: Just a matter of dose[J]. Rev Med Interne, 2019, 40: 670-676. DOI: 10.1016/j.revmed.2019.04.003
    [17]
    Schjørring OL, Klitgaard TL, Perner A, et al. Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure[J]. N Engl J Med, 2021, 8, 384: 1301-1311.
    [18]
    Barrot L, Asfar P, Mauny F, et al. Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome[J]. N Engl J Med, 2020, 382: 999-1008. DOI: 10.1056/NEJMoa1916431
    [19]
    ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group, Mackle D, Bellomo R, et al. Conservative Oxygen Therapy during Mechanical Ventilation in the ICU[J]. N Engl J Med, 2020, 12, 382: 989-998.
    [20]
    Girardis M, Busani S, Damiani E, et al. Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit: The Oxygen-ICU Randomized Clinical Trial[J]. JAMA, 2016, 316: 1583-1589. DOI: 10.1001/jama.2016.11993
    [21]
    Palmer E, Post B, Klapaukh R, et al. The Association between Supraphysiologic Arterial Oxygen Levels and Mortality in Critically Ill Patients. A Multicenter Observational Cohort Study[J]. Am J Respir Crit Care Med, 2019, 200: 1373-1380. DOI: 10.1164/rccm.201904-0849OC
    [22]
    Crapo JD, Hayatdavoudi G, Knapp MJ, et al. Progressive alveolar septal injury in primates exposed to 60% oxygen for 14 days[J]. Am J Physiol, 1994, 267: L797-L806.
    [23]
    Altemeier WA, Sinclair SE. Hyperoxia in the intensive care unit: why more is not always better[J]. Curr Opin Crit Care, 2007, 13: 73-78. DOI: 10.1097/MCC.0b013e32801162cb
    [24]
    Six S, Jaffal K, Ledoux G, et al. Hyperoxemia as a risk factor for ventilator-associated pneumonia[J]. Crit Care, 2016, 20: 195. DOI: 10.1186/s13054-016-1368-4
    [25]
    Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness[J]. N Engl J Med, 2014, 371: 287-288. DOI: 10.1056/NEJMc1406274
    [26]
    Farquhar H, Weatherall M, Wijesinghe M, et al. Systematic review of studies of the effect of hyperoxia on coronary blood flow[J]. Am Heart J, 2009, 158: 371-377. DOI: 10.1016/j.ahj.2009.05.037
    [27]
    Ni YN, Wang YM, Liang BM, et al. The effect of hyperoxia on mortality in critically ill patients: a systematic review and meta analysis[J]. BMC Pulm Med, 2019, 19: 53. DOI: 10.1186/s12890-019-0810-1
    [28]
    Martin DS, Grocott MP. Oxygen therapy in critical illness: precise control of arterial oxygenation and permissive hypoxemia[J]. Crit Care Med, 2013, 41: 423-432. DOI: 10.1097/CCM.0b013e31826a44f6
    [29]
    He HW, Liu DW. Permissive hypoxemia/conservative oxygenation strategy: Dr. Jekyll or Mr. Hyde?[J]. J Thorac Dis, 2016, 8: 748-750. DOI: 10.21037/jtd.2016.03.58
    [30]
    Barbateskovic M, Schjørring OL, Russo Krauss S, et al. Higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit[J]. Cochrane Database Syst Rev, 2019, 2019: CD012631.
    [31]
    Choi BM, Kang BJ, Yun HY, et al. Performance of the MP570T pulse oximeter in volunteers participating in the controlled desaturation study: a comparison of seven probes[J]. Anesth Pain Med (Seoul), 2020, 31, 15: 371-377.
    [32]
    Ambrisko TD, Dantino SC, Keating SCJ, et al. Repea-tability and accuracy of fingertip pulse oximeters for measurement of hemoglobin oxygen saturation in arterial blood and pulse rate in anesthetized dogs breathing 100% oxygen[J]. Am J Vet Res, 2021, 82: 268-273. DOI: 10.2460/ajvr.82.4.268
    [33]
    Philip KEJ, Bennett B, Fuller S, et al. Working accuracy of pulse oximetry in COVID-19 patients stepping down from intensive care: a clinical evaluation[J]. BMJ Open Respir Res, 2020, 7: e000778. DOI: 10.1136/bmjresp-2020-000778
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