Friess Jan O, Mikasi Jan, Baumann Rico, Ranjan Rajevan, Fischer Kady, Levis Anja, Terbeck Sandra, Hirschi Trevor, Gerber Daniel, Erdoes Gabor, Schoenhoff Florian S, Carrel Thierry P, Madhkour Raouf, Eberle Balthasar, Guensch Dominik P
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
BJA Open. 2023 Apr 27;6:100135. doi: 10.1016/j.bjao.2023.100135. eCollection 2023 Jun.
There are no current recommendations for oxygen titration in patients with stable coronary artery disease. This study investigates the effect of iatrogenic hyperoxia on cardiac function in patients with coronary artery disease undergoing general anaesthesia.
Patients scheduled for elective coronary artery bypass graft surgery were prospectively recruited into this randomised crossover clinical trial. All patients were exposed to inspired oxygen fractions of 0.3 (normoxaemia) and 0.8 (hyperoxia) in randomised order. A transoesophageal echocardiographic imaging protocol was performed during each exposure. Primary analysis investigated changes in 3D peak strain, whereas secondary analyses investigated other systolic and diastolic responses.
There was no statistical difference in systolic function between normoxaemia and hyperoxia. However, the response in systolic function to hyperoxia was dependent on ventricular function at normoxaemia. Patients with a normoxaemic left ventricular (LV) global longitudinal strain (GLS) poorer than the derived cut-off (>-15.4%) improved with hyperoxia (<0.01), whereas in patients with normoxaemic LV-GLS <-15.4%, LV-GLS worsened with transition to hyperoxia (<0.01). The same was seen for right ventricular GLS with a cut-off at -24.1%. Diastolic function worsened during hyperoxia indicated by a significant increase of averaged /' (8.6 [2.6]. 8.2 [2.4], =0.01) and / ratio (1.4 (0.4) 1.3 (0.4), =0.01).
Although the response of biventricular systolic variables is dependent on systolic function at normoxaemia, diastolic function consistently worsens under hyperoxia. In coronary artery disease, intraoperative strain analysis may offer guidance for oxygen titration.
NCT04424433.
目前尚无关于稳定型冠状动脉疾病患者氧疗滴定的推荐。本研究调查了医源性高氧对接受全身麻醉的冠状动脉疾病患者心功能的影响。
计划进行择期冠状动脉搭桥手术的患者被前瞻性纳入这项随机交叉临床试验。所有患者随机依次接受吸入氧分数为0.3（正常氧血症）和0.8（高氧）的治疗。每次治疗期间均进行经食管超声心动图成像检查。主要分析研究三维峰值应变的变化，次要分析研究其他收缩期和舒张期反应。
正常氧血症和高氧血症之间的收缩功能无统计学差异。然而，收缩功能对高氧的反应取决于正常氧血症时的心室功能。正常氧血症时左心室（LV）整体纵向应变（GLS）低于推导临界值（>-15.4%）的患者，高氧治疗后改善（<0.01），而正常氧血症时LV-GLS<-15.4%的患者，转为高氧后LV-GLS恶化（<0.01）。右心室GLS以-24.1%为临界值时情况相同。高氧期间舒张功能恶化，表现为平均E/A（8.６[2.6]比8.2[2.4]，P=0.01）和E/A比值（1.4[0.4]比1.3[0.4]，P=0.01）显著增加。
虽然双心室收缩期变量的反应取决于正常氧血症时的收缩功能，但高氧状态下舒张功能持续恶化。在冠状动脉疾病中，术中应变分析可为氧疗滴定提供指导。
NCT04424433。
