本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.2933

摘要内容如下：

重要性

在患有危重疾病的成年人中，随机试验尚未发现氧合目标会影响总体结果。氧合目标的影响是否因个体特征而异尚不清楚。

目的

确定个体特征是否改变较低与较高外周血氧饱和度（SpO2）目标对死亡率的影响。

设计、设置和参与者

在最佳氧疗目标的实用研究（Pilot）试验中得出了一个机器学习模型，用于预测较低与较高SpO2目标治疗对个体患者死亡率的影响，并在重症监护病房随机试验（ICU-ROX）中进行了外部验证，该试验比较了两种氧疗方法。2018年7月至2021年8月，美国一家重症监护室（ICU）的Pilot（n=1682）以及2015年9月至2018年5月，澳大利亚和新西兰21家ICU的ICU-ROX（n=965）接受了危重成人有创机械通气治疗。

曝光

随机分为低SpO2目标组和高SpO2目标组。

主要成果和措施

28天死亡率。

结果

在ICU-ROX验证队列中，个体患者采用较低与较高SpO2目标治疗的预测效果范围为28天死亡率绝对降低27.2%至绝对增加34.4%。例如，预计受益于较低SpO2目标的患者急性脑损伤的发生率较高，而预计受益于较高SpO2目标的患者败血症和生命体征异常升高的发生率较高。预测受益于较低SpO2目标的患者在随机分配到较低SpO2组时死亡率较低，而预测受益于较高SpO2目标的患者在随机分配到较高SpO2组时死亡率较低（效应修正的似然比检验P=.02）。使用预测对每个患者最好的SpO2目标，而不是随机SpO2目标，将使绝对总死亡率降低6.4%（95%CI，1.9%-10.9%）。

结论和相关性

使用随机试验的机器学习分析个体化的氧合目标可能会降低危重成人的死亡率。需要一项前瞻性试验来评估个体化氧合目标的使用。

英文原文如下：

Abstracts

Importance  Among critically ill adults, randomized trials have not found oxygenation targets to affect outcomes overall. Whether the effects of oxygenation targets differ based on an individual's characteristics is unknown.

Objective  To determine whether an individual's characteristics modify the effect of lower vs higher peripheral oxygenation-saturation (Spo2) targets on mortality.

Design, Setting, and Participants  A machine learning model to predict the effect of treatment with a lower vs higher Spo2 target on mortality for individual patients was derived in the Pragmatic Investigation of Optimal Oxygen Targets (PILOT) trial and externally validated in the Intensive Care Unit Randomized Trial Comparing Two Approaches to Oxygen Therapy (ICU-ROX) trial. Critically ill adults received invasive mechanical ventilation in an intensive care unit (ICU) in the United States between July 2018 and August 2021 for PILOT (n = 1682) and in 21 ICUs in Australia and New Zealand between September 2015 and May 2018 for ICU-ROX (n = 965).

Exposures  Randomization to a lower vs higher Spo2 target group.

Main Outcome and Measure  28-Day mortality.

Results  In the ICU-ROX validation cohort, the predicted effect of treatment with a lower vs higher Spo2 target for individual patients ranged from a 27.2% absolute reduction to a 34.4% absolute increase in 28-day mortality. For example, patients predicted to benefit from a lower Spo2 target had a higher prevalence of acute brain injury, whereas patients predicted to benefit from a higher Spo2 target had a higher prevalence of sepsis and abnormally elevated vital signs. Patients predicted to benefit from a lower Spo2 target experienced lower mortality when randomized to the lower Spo2 group, whereas patients predicted to benefit from a higher Spo2 target experienced lower mortality when randomized to the higher Spo2 group (likelihood ratio test for effect modification P = .02). The use of a Spo2 target predicted to be best for each patient, instead of the randomized Spo2 target, would have reduced the absolute overall mortality by 6.4% (95% CI, 1.9%-10.9%).

Conclusion and relevance  Oxygenation targets that are individualized using machine learning analyses of randomized trials may reduce mortality for critically ill adults. A prospective trial evaluating the use of individualized oxygenation targets is needed.

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