From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan (S.S., Y.M., Y.H., S.O., H.M.) Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan (T.I., A.S.). Atago Hospital, Kochi Chikamori Hospital, Kochi Fukuyama City Hospital, Hiroshima Fukuyama Medical Center, Hiroshima Himeji Central Hospital, Hyogo Hiroshima City Hiroshima Citizens Hospital, Hiroshima Iwakuni Medical Center, Yamaguchi Japanese Red Cross Kobe Hospital, Hyogo Japanese Red Cross Okayama Hospital, Okayama Japanese Red Cross Society Himeji Hospital, Hyogo Japanese Red Cross Society Mihara Hospital, Hiroshima Jichi Medical University Hospital, Tochigi Kagawa Prefectural Central Hospital, Kagawa Kagawa Rosai Hospital, Kagawa Kajiki Hospital, Okayama Kameda Medical Center, Chiba Kawasaki Medical School General Medical Center, Okayama Kawasaki Medical School Hospital, Okayama Kobe University Hospital, Hyogo Kochi Health Sciences Center, Kochi Kochi Medical School Hospital, Kochi Kurashiki Medical Center, Okayama Maizuru Kyosai Hospital, Kyoto Matsuda Hospital, Okayama Mitoyo General Hospital, Kagawa Mizushima Kyodo Hospital, Okayama National Cancer Center Hospital, Tokyo Okayama City Hospital, Okayama Okayama Kyokuto Hospital, Okayama Okayama Kyoritsu General Hospital, Okayama Okayama Medical Center, Okayama Okayama Rosai Hospital, Okayama Okayama Saiseikai General Hospital, Okayama Onomichi Municipal Hospital, Hiroshima Saiseikai Imabari Hospital, Ehime Shizuoka Cancer Center, Shizuoka Showa University Northern Yokohama Hospital, Kanagawa Takasago Municipal Hospital, Hyogo Takinomiya General Hospital, Kagawa Tottori Municipal Hospital, Tottori Tsuyama Chuo Hospital, Okayama Yashima General Hospital, Kagawa.
Anesthesiology. 2018 Jul;129(1):67-76. doi: 10.1097/ALN.0000000000002181.
Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia.
A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%).
A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60).
Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.
术中氧管理了解甚少。据推测，全身麻醉期间普遍存在潜在可预防的高氧血症和大量氧气暴露。
本研究开展了一项多中心、横断面研究，以描述日本全身麻醉期间的当前呼吸机管理，特别是氧管理。在 2015 年的 43 家参与医院中，确定连续 5 天接受全身麻醉的所有成年患者（16 岁或以上）。在全身麻醉诱导后 1 小时收集呼吸机设置和生命体征。我们确定了潜在可预防的高氧血症（脉搏血氧饱和度仪测量的氧饱和度超过 98%，尽管吸入氧分压超过 0.21）的患病率，以及潜在大量氧气暴露的危险因素（脉搏血氧饱和度仪测量的氧饱和度超过 92%，尽管吸入氧分压超过 0.5）。
共发现 1786 例符合条件的患者，其中 1498 例完成了研究。1385 例患者（92%）的吸入氧分压在 0.31 至 0.6 之间，而极少数患者（1%）的吸入氧分压低于或等于 0.3。大多数患者（83%）存在潜在可预防的高氧血症，32%存在潜在大量氧气暴露。多变量分析显示，年龄较大、急诊手术和单肺通气与潜在大量氧气暴露增加独立相关，而使用容量控制通气和高水平呼气末正压与潜在大量氧气暴露减少相关。单肺通气是潜在大量氧气暴露的一个特别强的危险因素（调整后的优势比，13.35；95%置信区间，7.24 至 24.60）。
全身麻醉期间，特别是单肺通气期间，普遍存在潜在可预防的高氧血症和大量氧气暴露。未来的研究应探讨术中氧治疗更保守方法的安全性和可行性。
