Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial
Abstract When hemoglobin (Hb) is fully saturated with oxygen, the additional gain in oxygen delivery (DO2) achieved by increasing the fraction of inspired oxygen (FiO2) is often considered clinically insignificant. In this study, we evaluated the change in DO2, interrogated by mixed venous oxygen sa...
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Nature Portfolio
2021-09-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-97555-2 |
| _version_ | 1818694586324746240 |
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| author | Karam Nam Hye-Bin Kim Young-Lan Kwak Young Hyun Jeong Jae-Woo Ju Jinyoung Bae Seohee Lee Youn Joung Cho Jae-Kwang Shim Yunseok Jeon |
| author_facet | Karam Nam Hye-Bin Kim Young-Lan Kwak Young Hyun Jeong Jae-Woo Ju Jinyoung Bae Seohee Lee Youn Joung Cho Jae-Kwang Shim Yunseok Jeon |
| author_sort | Karam Nam |
| collection | DOAJ |
| description | Abstract When hemoglobin (Hb) is fully saturated with oxygen, the additional gain in oxygen delivery (DO2) achieved by increasing the fraction of inspired oxygen (FiO2) is often considered clinically insignificant. In this study, we evaluated the change in DO2, interrogated by mixed venous oxygen saturation (SvO2), in response to a change in FiO2 of 0.5 during cardiac surgery. When patients were hemodynamically stable, FiO2 was alternated between 0.5 and 1.0 in on-pump cardiac surgery patients (pilot study), and between 0.3 and 0.8 in off-pump coronary artery bypass grafting patients (substudy of the CARROT trial). After the patient had stabilized, a blood gas analysis was performed to measure SvO2. The observed change in SvO2 (ΔSvO2) was compared to the expected ΔSvO2 calculated using Fick’s equation. A total 106 changes in FiO2 (two changes per patient; total 53 patients; on-pump, n = 36; off-pump, n = 17) were finally analyzed. While Hb saturation remained near 100% (on-pump, 100%; off-pump, mean [SD] = 98.1% [1.5] when FiO2 was 0.3 and 99.9% [0.2] when FiO2 was 0.8), SvO2 changed significantly as FiO2 was changed (the first and second changes in on-pump, 7.7%p [3.8] and 7.6%p [3.5], respectively; off-pump, 7.9%p [4.9] and 6.2%p [3.9]; all P < 0.001). As a total, regardless of the surgery type, the observed ΔSvO2 after the FiO2 change of 0.5 was ≥ 5%p in 82 (77.4%) changes and ≥ 10%p in 31 (29.2%) changes (mean [SD], 7.5%p [3.9]). Hb concentration was not correlated with the observed ΔSvO2 (the first changes, r = − 0.06, P = 0.677; the second changes, r = − 0.21, P = 0.138). The mean (SD) residual ΔSvO2 (observed − expected ΔSvO2) was 0%p (4). Residual ΔSvO2 was more than 5%p in 14 (13.2%) changes and exceeded 10%p in 2 (1.9%) changes. Residual ΔSvO2 was greater in patients with chronic kidney disease than in those without (median [IQR], 5%p [0 to 7] vs. 0%p [− 3 to 2]; P = 0.049). DO2, interrogated by SvO2, may increase to a clinically significant degree as FiO2 is increased during cardiac surgery, and the increase of SvO2 is not related to Hb concentration. SvO2 increases more than expected in patients with chronic kidney disease. Increasing FiO2 can be used to increase DO2 during cardiac surgery. |
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| last_indexed | 2024-12-17T13:31:56Z |
| publishDate | 2021-09-01 |
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| spelling | doaj.art-9ea99fa39c3e4a93bfa813cfb1fb0a8a2022-12-21T21:46:32ZengNature PortfolioScientific Reports2045-23222021-09-0111111010.1038/s41598-021-97555-2Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trialKaram Nam0Hye-Bin Kim1Young-Lan Kwak2Young Hyun Jeong3Jae-Woo Ju4Jinyoung Bae5Seohee Lee6Youn Joung Cho7Jae-Kwang Shim8Yunseok Jeon9Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of MedicineDepartment of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineAbstract When hemoglobin (Hb) is fully saturated with oxygen, the additional gain in oxygen delivery (DO2) achieved by increasing the fraction of inspired oxygen (FiO2) is often considered clinically insignificant. In this study, we evaluated the change in DO2, interrogated by mixed venous oxygen saturation (SvO2), in response to a change in FiO2 of 0.5 during cardiac surgery. When patients were hemodynamically stable, FiO2 was alternated between 0.5 and 1.0 in on-pump cardiac surgery patients (pilot study), and between 0.3 and 0.8 in off-pump coronary artery bypass grafting patients (substudy of the CARROT trial). After the patient had stabilized, a blood gas analysis was performed to measure SvO2. The observed change in SvO2 (ΔSvO2) was compared to the expected ΔSvO2 calculated using Fick’s equation. A total 106 changes in FiO2 (two changes per patient; total 53 patients; on-pump, n = 36; off-pump, n = 17) were finally analyzed. While Hb saturation remained near 100% (on-pump, 100%; off-pump, mean [SD] = 98.1% [1.5] when FiO2 was 0.3 and 99.9% [0.2] when FiO2 was 0.8), SvO2 changed significantly as FiO2 was changed (the first and second changes in on-pump, 7.7%p [3.8] and 7.6%p [3.5], respectively; off-pump, 7.9%p [4.9] and 6.2%p [3.9]; all P < 0.001). As a total, regardless of the surgery type, the observed ΔSvO2 after the FiO2 change of 0.5 was ≥ 5%p in 82 (77.4%) changes and ≥ 10%p in 31 (29.2%) changes (mean [SD], 7.5%p [3.9]). Hb concentration was not correlated with the observed ΔSvO2 (the first changes, r = − 0.06, P = 0.677; the second changes, r = − 0.21, P = 0.138). The mean (SD) residual ΔSvO2 (observed − expected ΔSvO2) was 0%p (4). Residual ΔSvO2 was more than 5%p in 14 (13.2%) changes and exceeded 10%p in 2 (1.9%) changes. Residual ΔSvO2 was greater in patients with chronic kidney disease than in those without (median [IQR], 5%p [0 to 7] vs. 0%p [− 3 to 2]; P = 0.049). DO2, interrogated by SvO2, may increase to a clinically significant degree as FiO2 is increased during cardiac surgery, and the increase of SvO2 is not related to Hb concentration. SvO2 increases more than expected in patients with chronic kidney disease. Increasing FiO2 can be used to increase DO2 during cardiac surgery.https://doi.org/10.1038/s41598-021-97555-2 |
| spellingShingle | Karam Nam Hye-Bin Kim Young-Lan Kwak Young Hyun Jeong Jae-Woo Ju Jinyoung Bae Seohee Lee Youn Joung Cho Jae-Kwang Shim Yunseok Jeon Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial Scientific Reports |
| title | Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial |
| title_full | Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial |
| title_fullStr | Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial |
| title_full_unstemmed | Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial |
| title_short | Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial |
| title_sort | effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery a substudy of the carrot trial |
| url | https://doi.org/10.1038/s41598-021-97555-2 |
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