Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea.
J Clin Anesth. 2021 Sep;72:110285. doi: 10.1016/j.jclinane.2021.110285. Epub 2021 Apr 7.
We evaluated the feasibility of use and effects on postoperative atelectasis and complications of lower inspired oxygen fraction (FIO) compared to conventional oxygen therapy.
Single center, randomized clinical trial.
University hospital, operating room and postoperative recovery area.
One hundred ninety patients aged ≥50 with an American Society of Anesthesiologists physical status of I-III who underwent abdominal surgery with general anesthesia.
Participants were randomly assigned to either the low FIO group (intraoperative: FIO 0.35, during induction and recovery: FIO 0.7) or the conventional FIO group (intraoperative: FIO 0.6, during induction and recovery: FIO 1.0).
The primary outcome was postoperative atelectasis measured with lung ultrasonography at postoperative 30 min in the post-anesthesia care unit (consolidation score: each region 0-3, 12 region, total score range of 0 to 36, a lower score indicating better aeration).
Seven patients in the low FIO group were omitted from the study due to changing FIO during intervention (7/95 (8.4%) vs. 2/95 (2.1%), p = 0.088; low FIO group vs. conventional FIO group). Overall, atelectasis was detected in 29.7% (51/172) of patients 30 min after surgery by lung ultrasound and 40.1% (69/172) of patients after 2 days after surgery by chest X-ray. The scores of lung ultrasonography and the incidence of significant atelectasis (consolidation score ≥ 2 at any region) were lower in the low FIO group than in the conventional FIO group (median [IQR]: 3 [1,6] vs. 7 [3,9], p < 0.001 and 17/85 (20%) vs. 34/87 (39%), RR: 0.512 [95% CI: 0.311-0.843], p = 0.006, respectively). The incidence of surgical site infection and length of hospitalization were not significantly different between the two groups.
Based on our findings, decreased inspired oxygen fraction during anesthesia and recovery did not cause hypoxic events, but instead reduced immediate postoperative atelectasis. The use of intraoperative conventional higher inspired oxygen did not afford any clinical advantages for postoperative recovery in abdominal surgery.
我们评估了与常规氧疗相比，使用较低吸入氧分数（FIO）对术后肺不张和并发症的可行性。
单中心、随机临床试验。
大学医院、手术室和术后恢复区。
190 名年龄≥50 岁、美国麻醉医师协会身体状况 I-III 级的接受全身麻醉下腹部手术的患者。
参与者被随机分配到低 FIO 组（术中：FIO 0.35，诱导和恢复时：FIO 0.7）或常规 FIO 组（术中：FIO 0.6，诱导和恢复时：FIO 1.0）。
主要结局是术后 30 分钟在麻醉后护理单元使用肺部超声测量的术后肺不张（合并评分：每个区域 0-3，12 个区域，总分范围为 0 至 36，得分越低表示通气越好）。
由于干预期间 FIO 发生变化，低 FIO 组有 7 名患者被排除在研究之外（7/95（8.4%）比 2/95（2.1%），p=0.088；低 FIO 组与常规 FIO 组）。总体而言，术后 30 分钟通过肺部超声检查发现 29.7%（51/172）的患者出现肺不张，术后 2 天通过胸部 X 线检查发现 40.1%（69/172）的患者出现肺不张。低 FIO 组的肺部超声评分和明显肺不张发生率（任何区域的合并评分≥2）均低于常规 FIO 组（中位数[IQR]：3[1,6]比 7[3,9]，p<0.001和 17/85（20%）比 34/87（39%），RR：0.512[95%CI：0.311-0.843]，p=0.006）。两组手术部位感染发生率和住院时间无显著差异。
根据我们的发现，麻醉和恢复期间降低吸入氧分数不会导致低氧事件，但会减少术后即刻肺不张。术中常规使用较高的吸入氧并不能为腹部手术的术后恢复带来任何临床优势。
