Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA; Institute of Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA; Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA.
Department of Public Health Sciences, Division of Biostatistics, University of Virginia, Charlottesville, VA, USA.
Br J Anaesth. 2024 Nov;133(5):1073-1084. doi: 10.1016/j.bja.2024.08.005. Epub 2024 Sep 11.
Limited data exist to guide oxygen administration during one-lung ventilation for thoracic surgery. We hypothesised that high intraoperative inspired oxygen fraction during lung resection surgery requiring one-lung ventilation is independently associated with postoperative pulmonary complications (PPCs).
We performed this retrospective multicentre study using two integrated perioperative databases (Multicenter Perioperative Outcomes Group and Society of Thoracic Surgeons General Thoracic Surgery Database) to study adult thoracic surgical procedures using one-lung ventilation. The primary outcome was a composite of PPCs (atelectasis, acute respiratory distress syndrome, pneumonia, respiratory failure, reintubation, and prolonged ventilation >48 h). The exposure of interest was high inspired oxygen fraction (FiO), defined by area under the curve of a FiO threshold > 80%. Univariate analysis and logistic regression modelling assessed the association between intraoperative FiO and PPCs.
Across four US medical centres, 141/2733 (5.2%) procedures conducted in 2716 patients (55% female; mean age 66 yr) resulted in PPCs. FiO was univariately associated with PPCs (adjusted OR [aOR]: 1.17, 95% confidence interval [CI]: 1.04-1.33, P=0.012). Logistic regression modelling showed that duration of one-lung ventilation (aOR: 1.20, 95% CI: 1.03-1.41, P=0.022), but not the time-weighted average FiO (aOR: 1.01, 95% CI: 1.00-1.02, P=0.165), was associated with PPCs.
Our results do not support limiting the inspired oxygen fraction for the purpose of reducing postoperative pulmonary complications in thoracic surgery involving one-lung ventilation.
目前用于指导胸外科单肺通气期间氧疗的相关数据有限。我们假设，在需要单肺通气的肺切除术手术中，术中吸入氧分数较高与术后肺部并发症（PPC）独立相关。
我们使用两个集成围手术期数据库（多中心围手术期结局组和胸外科医师学会普通胸外科数据库）进行了这项回顾性多中心研究，研究对象为使用单肺通气的成人胸部手术。主要结局是 PPC（肺不张、急性呼吸窘迫综合征、肺炎、呼吸衰竭、再插管和通气时间>48 小时）的复合结果。我们感兴趣的暴露因素是高吸入氧分数（FiO），通过 FiO 阈值曲线下面积>80%来定义。单变量分析和逻辑回归模型评估了术中 FiO 与 PPC 之间的关联。
在四个美国医疗中心，2716 例患者（55%为女性；平均年龄 66 岁）的 2733 例手术中有 141 例（5.2%）出现 PPC。FiO 与 PPC 呈单变量相关（校正后的比值比[aOR]：1.17，95%置信区间[CI]：1.04-1.33，P=0.012）。逻辑回归模型显示，单肺通气持续时间（aOR：1.20，95% CI：1.03-1.41，P=0.022），而不是时间加权平均 FiO（aOR：1.01，95% CI：1.00-1.02，P=0.165），与 PPC 相关。
我们的研究结果不支持为了降低单肺通气胸外科手术术后肺部并发症而限制吸入氧分数。
