| Objective: To study clinical prognostic value of oxygen challenge test(OCT) in septic shock patients complicated with acute respiratory distress syndrome(ARDS) and effect of respiratory status on it. Methods:We performed this single center prospective observational study in department of the First Affiliated Hospital of Suzhou University’s intensive care unit(ICU). From According to the preset inclusion criterion from February 2015 to February 2016 patients admitted to ICU diagnosed as septic shock receiving mechanical ventilation were included in this research. All patients received early goal directed therapy(EGDT) resuscitation bundles and lung protective ventilation as well as other routine clinical management strategy.The patients were divided into several groups:1.survival group and nonsurvival group according to 28-day prognosis.The hemodynamic, respiratory and oximetric parameters were analyzed at T0,the 6th hour of admission(T6) and the 24 th hour of admission(T24) respectively. 2.the patients were divided into compliance and non-compliance groups. The nonsurvival rates, hemodynamic,respiratory and oximetric parameters were analyzed.3. At the 24 th hour of admission,the patients were divided and compared in two subgroups of P/F≥200mm Hg and P/F<200mm Hg according to oxygenation index.Whether the transcutaneous oxygen pressure(Pct O2) increase exceeding 40 mm Hg after the oxygen challenge test, There were also two groups of OCT(+)≥40mm Hg and OCT(-)< 40 mm Hg.The patients were also grouped according to whether P/F was still less than 200 mm Hg,which were“Persistent ARDS” group and“Transient ARDS”group.Results:1. There were 41 patients included in the research. Mortalty at 28 was 26.8%(11of41). SOFA were statistical difference between the survival group and nonsurvival group. Compared with the nonsurvival group, fraction of inspire oxygen(Fi O2)was lower(0.46±0.03 vs.0.56±0.11, P<0.05), and the Pa O2 at Fi O21.0 was higher(302±96mm Hg vs. 228±78mm Hg, P < 0.05), respectively for the survival group. But the Pct O2 value did not show much differences between two groups. At T6,norepinephrinedose(0.41±0.21ug/kg.minvs.0.69±0.39ug/kg.min,P<0.01),lacticacid(2.4±2.1mmol/Lvs.4.6±2.0mmol/L,P<0.001),?Ptc O2(94±42mm Hg vs.51±16mm Hg, P<0.05) were statistical difference.At T24, Acute physiology and chronic health evaluationⅡ(19±6vs.27±6,P<0.001),NE(0.32±0.22ug/kg.min vs. 0.76±0.33ug/kg.min, P<0.001),Lac(1.9±1.3mmol/L vs. 3.7±1.7mmol/L,P < 0.001),?Pa O2(241±102mm Hg vs.135±64mm Hg,P<0.01),?Ptc O2(139±81mm Hg vs.75±47mm Hg, P < 0.01)show statistical difference between survival and nonsurvival. The ?Ptc O2 and ?Pa O2 during OCT were correlated(r=0.072, P<0.01). The area under the ROC curve for the OCT and prognosis was 0.76(95% confidence interval 0.58-0.9). 2.There were 21 patients(51%)for EGDT compliance group and 20 patients(49%) for non-compliance group. There were significant differences in P/F、Pa O2 at Fi O2 1.0, ?Pa O2, Pct O2, Pct O2 at Fi O2 1.0, OCT for the compliance group are significantly higher than those of non-compliance group.3.At T24,the death rate was significantly higher in OCT(-)group than OCT(+) group; The group of P/F≥200mm Hg group showed higher Pct O2 and ?Ptc O2 than the P/F<200mm Hg group during OCT. There was significant difference made by low OCT(-) level(4% vs.53%,P<0.001).The group with lower OCT tended to have more severe of ARDS.The death rate of“Transient ARDS” group was significant lower than “Persistent ARDS” group(25% vs.80%,P<0.05), and the ?Ptc O2 was higher(112±85mm Hg vs. 31±14mm Hg, P<0.01). In occurrence rates of OCT(-), the “Persistent ARDS” was higher(0 vs. 80%,P<0.001).Conclusion:1.OCT based on the Ptc O2 monitoring technology could be used as a method to evaluate the prognosis in patients receiving mechanical ventilation with septic shock.2.OCT was helpful to evaluate the effect of EGDT in resuscitation and tissue perfusion in septic shock patients.3.The value of OCT could be related with respiratory status. |
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