Douin David J, Pattee Jack, Scott Benjamin, Fernandez-Bustamante Ana, Prin Meghan, Eckle Tobias, Ginde Adit A, Clendenen Nathan
Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.
Crit Care Explor. 2023 Mar 2;5(3):e0878. doi: 10.1097/CCE.0000000000000878. eCollection 2023 Mar.
The use of hyperoxemia during cardiac surgery remains controversial. We hypothesized that intraoperative hyperoxemia during cardiac surgery is associated with an increased risk of postoperative pulmonary complications.
Retrospective cohort study.
We analyzed intraoperative data from five hospitals within the Multicenter Perioperative Outcomes Group between January 1, 2014, and December 31, 2019. We assessed intraoperative oxygenation of adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Hyperoxemia pre and post CPB was quantified as the area under the curve (AUC) of Fio above 0.21 in minutes when the corresponding peripheral oxygen saturation was greater than 92% measured by pulse oximetry. We quantified hyperoxemia during CPB as the AUC of Pao greater than 200 mm Hg measured by arterial blood gas. We analyzed the association of hyperoxemia during all phases of cardiac surgery with the frequency of postoperative pulmonary complications within 30 days, including acute respiratory insufficiency or failure, acute respiratory distress syndrome, need for reintubation, and pneumonia.
Twenty-one thousand six hundred thirty-two cardiac surgical patients.
None.
During 21,632 distinct cardiac surgery cases, 96.4% of patients spent at least 1 minute in hyperoxemia (99.1% pre-CPB, 98.5% intra-CPB, and 96.4% post-CPB). Increasing exposure to hyperoxemia was associated with an increased risk of postoperative pulmonary complications throughout three distinct surgical periods. During CPB, increasing exposure to hyperoxemia was associated with an increased odds of developing postoperative pulmonary complications ( < 0.001) in a linear manner. Hyperoxemia before CPB ( < 0.001) and after CPB ( = 0.02) were associated with increased odds of developing postoperative pulmonary complications in a U-shaped relationship.
Hyperoxemia occurs almost universally during cardiac surgery. Exposure to hyperoxemia assessed continuously as an AUC during the intraoperative period, but particularly during CPB, was associated with an increased incidence of postoperative pulmonary complications.
心脏手术期间使用高氧血症仍存在争议。我们假设心脏手术期间的术中高氧血症与术后肺部并发症风险增加有关。
回顾性队列研究。
我们分析了多中心围手术期结局组中五家医院在2014年1月1日至2019年12月31日期间的术中数据。我们评估了接受体外循环（CPB）心脏手术的成年患者的术中氧合情况。CPB前后的高氧血症被量化为当通过脉搏血氧饱和度测量的相应外周血氧饱和度大于92%时，Fio高于0.21的分钟曲线下面积（AUC）。我们将CPB期间的高氧血症量化为通过动脉血气测量的Pao大于200 mmHg的AUC。我们分析了心脏手术所有阶段的高氧血症与30天内术后肺部并发症发生频率的关联，包括急性呼吸功能不全或衰竭、急性呼吸窘迫综合征、再次插管需求和肺炎。
21632例心脏手术患者。
无。
在21632例不同的心脏手术病例中，96.4%的患者至少有1分钟处于高氧血症状态（CPB前99.1%，CPB期间98.5%，CPB后96.4%）。在三个不同手术阶段，高氧血症暴露增加与术后肺部并发症风险增加相关。在CPB期间，高氧血症暴露增加与术后肺部并发症发生几率增加呈线性相关（<0.001）。CPB前的高氧血症（<0.001）和CPB后的高氧血症（=0.02）与术后肺部并发症发生几率增加呈U形关系。
心脏手术期间几乎普遍会出现高氧血症。术中持续以AUC评估的高氧血症暴露，尤其是在CPB期间，与术后肺部并发症发生率增加有关。
