心脏手术中的术中氧疗实践：全国性调查。
Intraoperative Oxygen Practices in Cardiac Surgery: A National Survey.
机构信息
Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
出版信息
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):2917-2926. doi: 10.1053/j.jvca.2022.01.019. Epub 2022 Jan 19.
OBJECTIVE
To describe the current nationwide perspectives and practice regarding intraoperative oxygen titration in cardiac surgery.
DESIGN
Prospective, observational survey.
SETTING
Hospitals across the United States.
PARTICIPANTS
Cardiovascular anesthesiologists and perfusionists.
INTERVENTIONS
Expert- and consensus-derived electronic surveys were sent to perfusionists and cardiac anesthesiologists to evaluate the current intraoperative practices around oxygen administration. Providers were asked about individual intraoperative oxygen titration practices used at different stages of cardiac surgical procedures. Anonymous responses were collected in the Research Electronic Data Capture (REDCap).
MEASUREMENTS AND MAIN RESULTS
A total of 3,335 providers were invited to participate, of whom 554 (317 anesthesiologists and 237 perfusionists) were included in the final analysis (17% response rate). During cardiopulmonary bypass (CPB), perfusionists reported a median (interquartile range [IQR]) target range from 150 (110-220)-to-325 mmHg (250-400), while anesthesiologists reported a significantly lower target range from 90 (70-150)-to-250 mmHg (158-400) (p values <0.0001 and 0.02, respectively). This difference was most pronounced at lower partial pressure of arterial oxygen (PaO) ranges. The median PaO considered "too low" by perfusionists was 100 mmHg (IQR 80-125), whereas it was 60 mmHg (IQR 60-75) for anesthesiologists, who reported for both off and on bypass. The median PaO considered "too high" was 375 mmHg (IQR 300-400) for perfusionists and 300 mmHg (IQR 200-400) for anesthesiologists. Anesthesiologists, therefore, reported more comfort with significantly lower PaO values (p < 0.0001), and considered a higher PaO value less desirable compared with perfusionists (p < 0.0001).
CONCLUSIONS
This survey demonstrated there was wide variation in oxygen administration practices between perfusionists and anesthesiologists. Hyperoxygenation was more common while on CPB.
目的
描述当前全美范围内关于心脏手术术中氧滴定的观点和实践。
设计
前瞻性、观察性调查。
地点
美国各地的医院。
参与者
心血管麻醉师和灌注师。
干预措施
向灌注师和心脏麻醉师发送专家和共识得出的电子调查，以评估术中供氧的当前实践。提供者被要求回答在心脏手术不同阶段使用的个体化术中氧滴定实践。匿名回复在 Research Electronic Data Capture（REDCap）中收集。
测量和主要结果
共邀请了 3335 名提供者参与，其中 554 名（317 名麻醉师和 237 名灌注师）被纳入最终分析（17%的回应率）。在体外循环（CPB）期间，灌注师报告的中位数（四分位距 [IQR]）目标范围为 150（110-220）至 325 mmHg（250-400），而麻醉师报告的目标范围明显较低，为 90（70-150）至 250 mmHg（158-400）（p 值分别<0.0001 和 0.02）。在较低的动脉血氧分压（PaO）范围内，这种差异最为明显。灌注师认为“过低”的中位数 PaO 为 100 mmHg（IQR 80-125），而麻醉师的中位数 PaO 为 60 mmHg（IQR 60-75），包括离线和在线 CPB。灌注师认为“过高”的中位数 PaO 为 375 mmHg（IQR 300-400），麻醉师为 300 mmHg（IQR 200-400）。因此，麻醉师报告对显著较低的 PaO 值更舒适（p<0.0001），与灌注师相比，他们认为较高的 PaO 值不太理想（p<0.0001）。
结论
本调查表明，灌注师和麻醉师之间的供氧实践存在广泛差异。CPB 时更常发生高氧血症。
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