Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications.
Hyperoxemia During Cardiac Surgery Is Associated With Postoperative Pulmonary Complications.
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DOI：
10.1097/cce.0000000000000878
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发表时间：
2023-03
影响因子：
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通讯作者：
Clendenen N
中科院分区：
文献类型：
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作者：
Douin DJ;Pattee J;Scott B;Fernandez-Bustamante A;Prin M;Eckle T;Ginde AA;Clendenen N
在心脏手术中使用高氧血症仍然存在争议。我们假设心脏手术期间术中高氧血症与术后肺部并发症风险增加相关。回顾性队列研究。我们分析了2014年1月1日至2019年12月31日期间多中心围手术期结局组内五家医院的术中数据。我们评估了接受体外循环（CPB）心脏手术的成人患者的术中氧合。CPB前和CPB后的高血氧定量为当相应的外周血氧饱和度大于92%（通过脉搏血氧仪测量）时Fio2高于0.21（分钟）的曲线下面积（AUC）。我们将CPB期间的高氧血症定量为动脉血气测量的Pao2的AUC大于200 mm Hg。我们分析了心脏手术各阶段的高氧血症与术后30天内肺部并发症发生率的关系，包括急性呼吸功能不全或衰竭、急性呼吸窘迫综合征、需要重新插管和肺炎。21632例心脏手术患者。没有。在21，632例不同的心脏手术病例中，96.4%的患者在高氧血症中至少持续1分钟（CPB前99.1%，CPB内98.5%，CPB后96.4%）。在三个不同的手术阶段，高氧血症暴露的增加与术后肺部并发症的风险增加相关。CPB期间，高氧血症暴露的增加与术后肺部并发症发生率的增加呈线性相关（p < 0.001）。CPB前（p < 0.001）和CPB后（p = 0.02）的高氧血症与发生术后肺部并发症的几率增加呈U形关系。高氧血症几乎普遍发生在心脏手术期间。在术中，特别是CPB期间，暴露于高氧血症（以AUC形式连续评估）与术后肺部并发症的发生率增加相关。
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. Retrospective cohort study. 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. Twenty-one thousand six hundred thirty-two cardiac surgical patients. None. 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. 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.
影响因子：
2.8
作者：
通讯作者：
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