Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications
OBJECTIVES:. The use of hyperoxemia during cardiac surgery remains controversial. We hypothesized that intraoperative hyperoxemia during cardiac surgery is associated with an increased risk of postoperative pulmonary complications. DESIGN:. Retrospective cohort study. SETTING:. We analyzed intraoper...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-03-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000878 |
| _version_ | 1797859637150613504 |
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| author | David J. Douin, MD Jack Pattee, PhD Benjamin Scott, MD Ana Fernandez-Bustamante, MD, PhD Meghan Prin, MD, MS Tobias Eckle, MD, PhD Adit A. Ginde, MD, MPH Nathan Clendenen, MD, MS |
| author_facet | David J. Douin, MD Jack Pattee, PhD Benjamin Scott, MD Ana Fernandez-Bustamante, MD, PhD Meghan Prin, MD, MS Tobias Eckle, MD, PhD Adit A. Ginde, MD, MPH Nathan Clendenen, MD, MS |
| author_sort | David J. Douin, MD |
| collection | DOAJ |
| description | OBJECTIVES:. The use of hyperoxemia during cardiac surgery remains controversial. We hypothesized that intraoperative hyperoxemia during cardiac surgery is associated with an increased risk of postoperative pulmonary complications.
DESIGN:. Retrospective cohort study.
SETTING:. We analyzed intraoperative data from five hospitals within the Multicenter Perioperative Outcomes Group between January 1, 2014, and December 31, 2019. We assessed intraoperative oxygenation of adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Hyperoxemia pre and post CPB was quantified as the area under the curve (AUC) of Fio2 above 0.21 in minutes when the corresponding peripheral oxygen saturation was greater than 92% measured by pulse oximetry. We quantified hyperoxemia during CPB as the AUC of Pao2 greater than 200 mm Hg measured by arterial blood gas. We analyzed the association of hyperoxemia during all phases of cardiac surgery with the frequency of postoperative pulmonary complications within 30 days, including acute respiratory insufficiency or failure, acute respiratory distress syndrome, need for reintubation, and pneumonia.
PATIENTS:. Twenty-one thousand six hundred thirty-two cardiac surgical patients.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. During 21,632 distinct cardiac surgery cases, 96.4% of patients spent at least 1 minute in hyperoxemia (99.1% pre-CPB, 98.5% intra-CPB, and 96.4% post-CPB). Increasing exposure to hyperoxemia was associated with an increased risk of postoperative pulmonary complications throughout three distinct surgical periods. During CPB, increasing exposure to hyperoxemia was associated with an increased odds of developing postoperative pulmonary complications (p < 0.001) in a linear manner. Hyperoxemia before CPB (p < 0.001) and after CPB (p = 0.02) were associated with increased odds of developing postoperative pulmonary complications in a U-shaped relationship.
CONCLUSIONS:. Hyperoxemia occurs almost universally during cardiac surgery. Exposure to hyperoxemia assessed continuously as an AUC during the intraoperative period, but particularly during CPB, was associated with an increased incidence of postoperative pulmonary complications. |
| first_indexed | 2024-04-09T21:33:57Z |
| format | Article |
| id | doaj.art-a2aa1c346d2c4e4bb99e06b2f698d811 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-09T21:33:57Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-a2aa1c346d2c4e4bb99e06b2f698d8112023-03-27T06:46:51ZengWolters KluwerCritical Care Explorations2639-80282023-03-0153e087810.1097/CCE.0000000000000878202303000-00007Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary ComplicationsDavid J. Douin, MD0Jack Pattee, PhD1Benjamin Scott, MD2Ana Fernandez-Bustamante, MD, PhD3Meghan Prin, MD, MS4Tobias Eckle, MD, PhD5Adit A. Ginde, MD, MPH6Nathan Clendenen, MD, MS71 Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.2 Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.1 Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.1 Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.1 Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.1 Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.3 Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.1 Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO.OBJECTIVES:. The use of hyperoxemia during cardiac surgery remains controversial. We hypothesized that intraoperative hyperoxemia during cardiac surgery is associated with an increased risk of postoperative pulmonary complications. DESIGN:. Retrospective cohort study. SETTING:. We analyzed intraoperative data from five hospitals within the Multicenter Perioperative Outcomes Group between January 1, 2014, and December 31, 2019. We assessed intraoperative oxygenation of adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Hyperoxemia pre and post CPB was quantified as the area under the curve (AUC) of Fio2 above 0.21 in minutes when the corresponding peripheral oxygen saturation was greater than 92% measured by pulse oximetry. We quantified hyperoxemia during CPB as the AUC of Pao2 greater than 200 mm Hg measured by arterial blood gas. We analyzed the association of hyperoxemia during all phases of cardiac surgery with the frequency of postoperative pulmonary complications within 30 days, including acute respiratory insufficiency or failure, acute respiratory distress syndrome, need for reintubation, and pneumonia. PATIENTS:. Twenty-one thousand six hundred thirty-two cardiac surgical patients. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. During 21,632 distinct cardiac surgery cases, 96.4% of patients spent at least 1 minute in hyperoxemia (99.1% pre-CPB, 98.5% intra-CPB, and 96.4% post-CPB). Increasing exposure to hyperoxemia was associated with an increased risk of postoperative pulmonary complications throughout three distinct surgical periods. During CPB, increasing exposure to hyperoxemia was associated with an increased odds of developing postoperative pulmonary complications (p < 0.001) in a linear manner. Hyperoxemia before CPB (p < 0.001) and after CPB (p = 0.02) were associated with increased odds of developing postoperative pulmonary complications in a U-shaped relationship. CONCLUSIONS:. Hyperoxemia occurs almost universally during cardiac surgery. Exposure to hyperoxemia assessed continuously as an AUC during the intraoperative period, but particularly during CPB, was associated with an increased incidence of postoperative pulmonary complications.http://journals.lww.com/10.1097/CCE.0000000000000878 |
| spellingShingle | David J. Douin, MD Jack Pattee, PhD Benjamin Scott, MD Ana Fernandez-Bustamante, MD, PhD Meghan Prin, MD, MS Tobias Eckle, MD, PhD Adit A. Ginde, MD, MPH Nathan Clendenen, MD, MS Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications Critical Care Explorations |
| title | Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications |
| title_full | Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications |
| title_fullStr | Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications |
| title_full_unstemmed | Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications |
| title_short | Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications |
| title_sort | hyperoxemia during cardiac surgery is associated with postoperative pulmonary complications |
| url | http://journals.lww.com/10.1097/CCE.0000000000000878 |
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