Khalife Maher, Salvagno Michele, Sosnowski Maurice, Balestra Costantino
Institut Jules Bordet, Anaesthesiology, H.U.B, Brussels, Belgium.
Department of Intensive Care, Hôpital Universitaire de Bruxelles (H.U.B), 1070, Brussels, Belgium.
J Anesth Analg Crit Care. 2024 Jul 8;4(1):43. doi: 10.1186/s44158-024-00179-x.
Anemia is common among hospitalized critically ill and surgical oncological patients. The rising incidence of cancer and aggressive treatments has increased the demand for blood products, further strained by a dwindling donor pool. The normobaric oxygen paradox (NOP) has emerged as a potential avenue to increase EPO levels. While some studies support its efficacy, research remains limited in clinical settings. This study aims to assess the effectiveness of a NOP protocol in stimulating erythropoiesis, as measured by changes in reticulocyte counts, in cancer patients undergoing abdominal surgeries.
This is a post hoc analysis of a prospective, single-center, controlled, randomized study. A total of 49 patients undergoing abdominal surgery were analyzed at the Institut Jules Bordet. Adult patients admitted to the intensive care unit (ICU) for at least 24 h were enrolled, excluding those with severe renal insufficiency or who received transfusions during the study period. Participants were randomized into two groups: a normobaric oxygen paradox (OXY) group who received 60% oxygen for 2 h on days 1, 3, and 5 post-surgery and a control (CTR) group who received standard care. Data on baseline characteristics, surgical details, and laboratory parameters were collected. Statistical analysis included descriptive statistics, chi-square tests, t-tests, Mann-Whitney tests, and linear and logistic regression.
The final analysis included 33 patients (median age 62 [IQR 58-66], 28 (84.8%) males, with no withdrawals or deaths during the study period. No significant differences were observed in baseline surgical characteristics or perioperative outcomes between the two groups. In the OXY group (n = 16), there was a significant rise (p = 0.0237) in the percentage of reticulocyte levels in comparison to the CTR group (n = 17), with median values of 36.1% (IQR 20.3-57.8) versus - 5.3% (IQR - 19.2-57.8), respectively. The increases in hemoglobin and hematocrit levels did not significantly differ between the groups when compared to their baselines' values.
This study provides preliminary evidence supporting the potential of normobaric oxygen therapy in stimulating erythropoiesis in cancer patients undergoing abdominal surgeries. While the OXY group resulted in increased reticulocyte counts, further research with larger sample sizes and multi-center trials is warranted to confirm these findings.
The study was retrospectively registered under NCT number 06321874 on The 10th of April 2024.
贫血在住院重症患者和外科肿瘤患者中很常见。癌症发病率的上升和积极的治疗增加了对血液制品的需求，而供血者群体的减少进一步加剧了这种紧张局面。常压氧悖论（NOP）已成为提高促红细胞生成素（EPO）水平的一个潜在途径。虽然一些研究支持其有效性，但在临床环境中的研究仍然有限。本研究旨在评估NOP方案在刺激红细胞生成方面的有效性，通过网织红细胞计数的变化来衡量，研究对象为接受腹部手术的癌症患者。
这是一项对前瞻性、单中心、对照、随机研究的事后分析。在朱尔斯·博尔代研究所对49例接受腹部手术的患者进行了分析。纳入入住重症监护病房（ICU）至少24小时的成年患者，排除那些有严重肾功能不全或在研究期间接受输血的患者。参与者被随机分为两组：常压氧悖论（OXY）组在术后第1、3和5天接受2小时60%的氧气吸入，对照组（CTR）接受标准护理。收集了关于基线特征、手术细节和实验室参数的数据。统计分析包括描述性统计、卡方检验、t检验、曼-惠特尼检验以及线性和逻辑回归。
最终分析纳入了33例患者（中位年龄62岁[四分位间距58 - 66岁]，28例（84.8%）为男性，研究期间无退出或死亡病例。两组在基线手术特征或围手术期结果方面未观察到显著差异。在OXY组（n = 16）中，与CTR组（n = 17）相比，网织红细胞水平百分比有显著上升（p = 0.0237），中位数分别为36.1%（四分位间距20.3 - 57.8）和 - （此处原文有误，推测为）5.3%（四分位间距 - 19.2 - 57.8）。与基线值相比，两组血红蛋白和血细胞比容水平的升高没有显著差异。
本研究提供了初步证据，支持常压氧疗法在刺激接受腹部手术的癌症患者红细胞生成方面的潜力。虽然OXY组导致网织红细胞计数增加，但需要更大样本量的进一步研究和多中心试验来证实这些发现。
该研究于2024年4月10日在NCT编号06321874下进行回顾性注册。
