Anesthesia and Surgical Critical Care, Hospital Universitario La Princesa, Madrid, Spain.
Anesthesia and Surgical Critical Care, Hospital Universitario La Princesa, Madrid, Spain.
J Cardiothorac Vasc Anesth. 2020 Feb;34(2):417-422. doi: 10.1053/j.jvca.2019.06.035. Epub 2019 Jun 28.
To determine the accuracy of the Oxygen Reserve Index (ORi) to predict hypoxemia during one-lung ventilation (OLV).
An observational diagnostic test study.
A tertiary care teaching hospital.
Forty consecutive patients scheduled for thoracic surgery with OLV.
Patients were ventilated with tidal volumes of 8 mL/kg ideal body weight during two-sided ventilation and 6 mL/kg during OLV, and with fraction of inspired oxygen (FO) of 60%. ORi was measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi = 0 in different phases of anesthesia. Hypoxemia during OLV was defined as SpO < 90%. Hypoxemia owing to malpositioning of the double lumen tube was an exclusion criterion. ORi = 0 five minutes after tracheal intubation in the supine position showed a sensitivity of 63.6% (confidence interval [CI] 95% 31.6-87.6), specificity of 93.1% (95% CI 75.8-98.8), and an accuracy of 85.0% (95% CI 69.5-93.8). The rate of hypoxemia was 27.5% (95% CI 15.14-44.14).
An ORi value equal to zero, 5 minutes after the onset of mechanical ventilation in the supine position, predicts the development of hypoxemia during OLV. These findings may be helpful to adjust FO individually in patients undergoing OLV and to avoid unnecessary high concentrations of oxygen.
确定氧储备指数（ORi）预测单肺通气（OLV）期间低氧血症的准确性。
观察性诊断测试研究。
三级护理教学医院。
40 名计划行 OLV 开胸手术的连续患者。
患者在双肺通气时以 8 mL/kg 理想体重的潮气量和 OLV 时以 6 mL/kg 的潮气量进行通气，并以 60%的吸入氧分数（FO）进行通气。连续测量 ORi。计算了 ORi=0 在麻醉不同阶段的灵敏度、特异性、阳性和阴性预测值、似然比和准确性。OLV 期间的低氧血症定义为 SpO<90%。双腔管位置不当导致的低氧血症为排除标准。气管插管后仰卧位 5 分钟时 ORi=0 的灵敏度为 63.6%（95%可信区间 31.6-87.6），特异性为 93.1%（95%可信区间 75.8-98.8），准确性为 85.0%（95%可信区间 69.5-93.8）。低氧血症的发生率为 27.5%（95%可信区间 15.14-44.14）。
机械通气仰卧位 5 分钟后 ORi 值等于零，可预测 OLV 期间低氧血症的发生。这些发现可能有助于在接受 OLV 的患者中单独调整 FO，并避免不必要的高浓度氧气。
