Nicholas J. Douville , Mark E. Smolkin , Bhiken I. Naik , Michael R. Mathis , Douglas A. Colquhoun , Sachin Kheterpal , Stephen R. Collins , Linda W. Martin , Wanda M. Popescu , Nathan L. Pace , Randal S. Blank
{"title":"胸外科手术中吸入氧分数与术后肺部并发症发生之间的关系:一项多中心回顾性队列研究。","authors":"Nicholas J. Douville , Mark E. Smolkin , Bhiken I. Naik , Michael R. Mathis , Douglas A. Colquhoun , Sachin Kheterpal , Stephen R. Collins , Linda W. Martin , Wanda M. Popescu , Nathan L. Pace , Randal S. Blank","doi":"10.1016/j.bja.2024.08.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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<sub>2</sub>), defined by area under the curve of a FiO<sub>2</sub> threshold > 80%. Univariate analysis and logistic regression modelling assessed the association between intraoperative FiO<sub>2</sub> and PPCs.</div></div><div><h3>Results</h3><div>Across four US medical centres, 141/2733 (5.2%) procedures conducted in 2716 patients (55% female; mean age 66 yr) resulted in PPCs. FiO<sub>2</sub> was univariately associated with PPCs (adjusted OR [aOR]: 1.17, 95% confidence interval [CI]: 1.04–1.33, <em>P</em>=0.012). Logistic regression modelling showed that duration of one-lung ventilation (aOR: 1.20, 95% CI: 1.03–1.41, <em>P</em>=0.022), but not the time-weighted average FiO<sub>2</sub> (aOR: 1.01, 95% CI: 1.00–1.02, <em>P</em>=0.165), was associated with PPCs.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 1073-1084"},"PeriodicalIF":9.1000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between inspired oxygen fraction and development of postoperative pulmonary complications in thoracic surgery: a multicentre retrospective cohort study\",\"authors\":\"Nicholas J. Douville , Mark E. Smolkin , Bhiken I. Naik , Michael R. Mathis , Douglas A. Colquhoun , Sachin Kheterpal , Stephen R. Collins , Linda W. Martin , Wanda M. Popescu , Nathan L. Pace , Randal S. Blank\",\"doi\":\"10.1016/j.bja.2024.08.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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<sub>2</sub>), defined by area under the curve of a FiO<sub>2</sub> threshold > 80%. Univariate analysis and logistic regression modelling assessed the association between intraoperative FiO<sub>2</sub> and PPCs.</div></div><div><h3>Results</h3><div>Across four US medical centres, 141/2733 (5.2%) procedures conducted in 2716 patients (55% female; mean age 66 yr) resulted in PPCs. FiO<sub>2</sub> was univariately associated with PPCs (adjusted OR [aOR]: 1.17, 95% confidence interval [CI]: 1.04–1.33, <em>P</em>=0.012). Logistic regression modelling showed that duration of one-lung ventilation (aOR: 1.20, 95% CI: 1.03–1.41, <em>P</em>=0.022), but not the time-weighted average FiO<sub>2</sub> (aOR: 1.01, 95% CI: 1.00–1.02, <em>P</em>=0.165), was associated with PPCs.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":9250,\"journal\":{\"name\":\"British journal of anaesthesia\",\"volume\":\"133 5\",\"pages\":\"Pages 1073-1084\"},\"PeriodicalIF\":9.1000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British journal of anaesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0007091224004707\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0007091224004707","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Association between inspired oxygen fraction and development of postoperative pulmonary complications in thoracic surgery: a multicentre retrospective cohort study
Background
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).
Methods
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 (FiO2), defined by area under the curve of a FiO2 threshold > 80%. Univariate analysis and logistic regression modelling assessed the association between intraoperative FiO2 and PPCs.
Results
Across four US medical centres, 141/2733 (5.2%) procedures conducted in 2716 patients (55% female; mean age 66 yr) resulted in PPCs. FiO2 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 FiO2 (aOR: 1.01, 95% CI: 1.00–1.02, P=0.165), was associated with PPCs.
Conclusions
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.
期刊介绍:
The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience.
The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence.
Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.