Choi Alex, Deng Hao, Fuller Mitchell, Sparling Jamie L, Zhu Min, Udelsman Brooks, Frendl Gyorgy, Vidal Melo Marcos F, Nagrebetsky Alexander
Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
J Clin Anesth. 2025 Feb;101:111739. doi: 10.1016/j.jclinane.2024.111739. Epub 2025 Jan 3.
To assess whether, in a lung resection cohort with a low probability of confounding by indication, higher FiO is associated with an increased risk of impaired postoperative oxygenation - a clinical manifestation of lung injury/dysfunction.
Pre-specified registry-based retrospective cohort study.
Two large academic hospitals in the United States.
2936 lung resection patients with an overall good intraoperative oxygenation (median intraoperative SpO ≥ 95 %).
We compared patients with a higher (≥0.8) and lower (<0.8) median intraoperative FiO after propensity score-weighting for 75 perioperative variables based on a causal inference framework. The primary outcome of impaired oxygenation 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) at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50 % oxygen or high-flow oxygen).
Among the 2936 included patients, 2171 (73.8 %) received median intraoperative FiO ≥ 0.8. Impaired postoperative oxygenation occurred in 1627 (74.9 %) and 422 (55.2 %) patients in the higher and lower FiO groups, respectively. In a propensity score-weighted analysis, higher intraoperative FiO was associated with an 84 % increase in the likelihood of impaired postoperative oxygenation (OR 1.84; 95 % CI 1.60 to 2.12; P < 0.001).
Despite plausible harm from hyperoxia, high intraoperative FiO is extremely common during lung resection. Nearly three-quarters of lung resection patients with acceptable oxygenation received median intraoperative FiO ≥ 0.8. Such higher FiO was associated with an increased risk of impaired postoperative oxygenation - a clinically relevant manifestation of lung injury or dysfunction. This observation supports the administration of a lower (< 0.8) intraoperative FiO and its further assessment in clinical trials.
在一个因指征导致混杂可能性较低的肺切除队列中，评估较高的吸入氧分数（FiO）是否与术后氧合受损风险增加相关，术后氧合受损是肺损伤/功能障碍的一种临床表现。
基于预先设定的注册登记的回顾性队列研究。
美国的两家大型学术医院。
2936例肺切除患者，术中氧合总体良好（术中SpO₂中位数≥95%）。
基于因果推断框架，对75个围手术期变量进行倾向评分加权后，我们比较了术中FiO中位数较高（≥0.8）和较低（<0.8）的患者。氧合受损的主要结局定义为术后7天内至少出现以下情况之一：（1）SpO₂<92%；（2）推算的动脉血氧分压/吸入氧分数（PaO₂/FiO）<300 mmHg[（1）或（2）在24小时内至少出现两次]；（3）强化氧疗（机械通气或吸氧浓度>50%或高流量吸氧）。
在纳入的2936例患者中，2171例（73.8%）术中FiO中位数≥0.8。较高FiO组和较低FiO组术后氧合受损的患者分别为1627例（74.9%）和422例（55.2%）。在倾向评分加权分析中，较高的术中FiO与术后氧合受损可能性增加84%相关（比值比1.84；95%置信区间1.60至2.12；P<0.001）。
尽管高氧可能存在危害，但在肺切除术中高术中FiO极为常见。近四分之三氧合可接受的肺切除患者术中FiO中位数≥0.8。这种较高的FiO与术后氧合受损风险增加相关，术后氧合受损是肺损伤或功能障碍的一种临床相关表现。这一观察结果支持在临床试验中采用较低（<0.8）的术中FiO并对其进行进一步评估。
