Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Clin Anesth. 2024 Sep;96:111485. doi: 10.1016/j.jclinane.2024.111485. Epub 2024 May 7.
To estimate the incidence of postoperative oxygenation impairment after lung resection in the era of lung-protective management, and to identify perioperative factors associated with that impairment.
Registry-based retrospective cohort study.
Two large academic hospitals in the United States.
3081 ASA I-IV patients undergoing lung resection.
79 pre- and intraoperative variables, selected for inclusion based on a causal inference framework. The primary outcome of impaired oxygenation, an early marker of lung injury, was defined as at least one of the following within seven postoperative days: (1) SpO < 92%; (2) imputed PaO/FiO < 300 mmHg [(1) or (2) occurring at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50% oxygen or high-flow oxygen).
Oxygenation was impaired within seven postoperative days in 70.8% of patients (26.6% with PaO/FiO < 200 mmHg or intensive oxygen therapy). In multivariable analysis, each additional cmHO of intraoperative median driving pressure was associated with a 7% higher risk of impaired oxygenation (OR 1.07; 95%CI 1.04 to 1.10). Higher median intraoperative FiO (OR 1.23; 95%CI 1.14 to 1.31 per 0.1) and PEEP (OR 1.12; 95%CI 1.04 to 1.21 per 1 cm HO) were also associated with increased risk. History of COPD (OR 2.55; 95%CI 1.95 to 3.35) and intraoperative albuterol administration (OR 2.07; 95%CI 1.17 to 3.67) also showed reliable effects.
Impaired postoperative oxygenation is common after lung resection and is associated with potentially modifiable pre- and intraoperative respiratory factors.
在肺保护管理时代，估计肺切除术后氧合受损的发生率，并确定与该受损相关的围手术期因素。
基于注册的回顾性队列研究。
美国的两家大型学术医院。
3081 名 ASA I-IV 级行肺切除术的患者。
选择了 79 个术前和术中变量，基于因果推理框架进行纳入。氧合受损的主要结局是，术后 7 天内至少出现以下一种情况：（1）SpO<92%；（2）推算的 PaO/FiO<300mmHg[（1）或（2）在 24 小时内至少出现两次]；（3）强化氧疗（机械通气或>50%氧气或高流量氧气）。
术后 7 天内，70.8%的患者发生氧合受损（26.6%的患者 PaO/FiO<200mmHg 或接受强化氧疗）。多变量分析显示，术中中位驱动压每增加 1cmHO，氧合受损的风险就会增加 7%（OR 1.07；95%CI 1.04 至 1.10）。术中中位 FiO（OR 1.23；95%CI 1.14 至 1.31，每增加 0.1）和 PEEP（OR 1.12；95%CI 1.04 至 1.21，每增加 1cmHO）也与风险增加相关。COPD 病史（OR 2.55；95%CI 1.95 至 3.35）和术中使用沙丁胺醇（OR 2.07；95%CI 1.17 至 3.67）也显示出可靠的效果。
肺切除术后氧合受损很常见，与潜在可改变的术前和术中呼吸因素有关。
