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。

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-09-11 DOI:10.1016/j.bja.2024.08.005

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引用次数: 0

摘要

背景用于指导胸外科手术单肺通气期间给氧的数据有限。我们假设，在需要单肺通气的肺切除手术中，术中高吸入氧分数与术后肺部并发症（PPCs）独立相关。方法我们使用两个综合围手术期数据库（多中心围手术期结果组和胸外科医师协会普通胸外科数据库）进行了这项回顾性多中心研究，研究使用单肺通气的成人胸外科手术。主要结果是 PPCs（肺不张、急性呼吸窘迫综合征、肺炎、呼吸衰竭、重新插管和通气时间延长 >48 小时）的综合结果。受关注的暴露是高吸入氧分压（FiO2），定义为 FiO2 阈值曲线下面积 > 80%。结果美国四个医疗中心的 2716 名患者（55% 为女性；平均年龄 66 岁）中有 141/2733 例（5.2%）手术导致了 PPCs。FiO2 与 PPCs 单变量相关（调整 OR [aOR]：1.17，95% 置信区间 [CI]：1.04-1.33，P=0.012）。逻辑回归模型显示，单肺通气持续时间（aOR：1.20，95% CI：1.03-1.41，P=0.022）与 PPCs 有关，而时间加权平均 FiO2（aOR：1.01，95% CI：1.00-1.02，P=0.165）与 PPCs 无关。

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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.

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

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.