Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2018 Aug;62(7):1014-1019. doi: 10.1111/aas.13123. Epub 2018 Apr 17.
Oxygen therapy is used liberally for all patients undergoing anaesthesia. Recent studies have raised concerns that it may not be without complications when arterial oxygen concentrations reach supranormal concentrations (hyperoxia). Studies of oxygen therapy have raised concerns that the risk of myocardial injury and infarction is elevated in patients with hyperoxia due to vasoconstriction and formation of reactive oxygen species. Due to lack of symptoms or silent ischaemia, post-operative myocardial injury may be missed clinically. In some studies, perioperative hyperoxia has been linked to increased long-term mortality, but cardiac complications are sparsely evaluated. The aim of this review is to summarize current evidence to assess the risk and benefits of perioperative hyperoxia on post-operative cardiac complications.
This systematic review will include meta-analyses and Trial Sequential Analyses. We will include randomized clinical trials with patients undergoing non-cardiac surgery if the allocation separates patients into a target of either higher (above 0.60) or lower (below 0.40) inspired oxygen fraction. To minimize the risk of systematic error, we will assess the risk of bias of the included trials using the Cochrane Risk of Bias Tool. The overall quality of evidence for each outcome will be assessed with the Grading of Recommendation, Assessment, Development and Evaluation (GRADE).
This systematic review will provide data on a severe, albeit rare, potential risk of oxygen therapy. We will do a trial sequential analysis to assess the robustness of results as well as help estimate the required patient size for future clinical trials.
氧气治疗在接受麻醉的所有患者中都被广泛使用。最近的研究引起了人们的关注，即在动脉氧浓度达到超正常浓度（高氧血症）时，它可能并非没有并发症。氧气治疗的研究引起了人们的关注，即由于血管收缩和活性氧形成，高氧血症患者的心肌损伤和梗死风险升高。由于缺乏症状或无症状性缺血，术后心肌损伤可能在临床上被忽略。在一些研究中，围手术期高氧血症与长期死亡率增加有关，但对心脏并发症的评估较少。本综述的目的是总结目前的证据，以评估围手术期高氧血症对术后心脏并发症的风险和益处。
本系统综述将包括荟萃分析和试验序贯分析。如果分配将患者分为较高（高于 0.60）或较低（低于 0.40）吸入氧分数的目标，则我们将包括接受非心脏手术的随机临床试验。为了最大程度地降低系统误差的风险，我们将使用 Cochrane 偏倚风险工具评估纳入试验的偏倚风险。我们将使用推荐、评估、开发和评估（GRADE）评估每个结局的证据总体质量。
本系统综述将提供关于严重的氧气治疗潜在风险的相关数据。我们将进行试验序贯分析，以评估结果的稳健性，并帮助估计未来临床试验所需的患者人数。
