驱动压力引导通气策略中吸气氧分压对开腹手术后肺部并发症的影响：随机对照试验

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-11-06 DOI:10.1016/j.jclinane.2024.111676

Yu-Tong Zhang , Yang Han , Hui-Jia Zhuang , Ai-Min Feng , Liang Jin , Xue-Fei Li , Hong Yu , Hai Yu

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引用次数: 0

摘要

研究目的本研究旨在确定在压力引导通气策略下，30%的吸入氧饱和度（FIO2）与80%的吸入氧饱和度（FIO2）相比，对开腹手术后肺部并发症的影响。干预措施患者被随机分配到术中接受 30% 或 80% 的 FIO2。所有患者均接受驱动压力引导的通气策略，包括低潮气量和以最低驱动压力设定的个性化 PEEP。主要结果在1553名通过资格评估的患者中，514名患者被随机分配，并按照意向治疗原则进行分析。与接受80% FIO2治疗的患者相比，接受30% FIO2治疗的患者术后肺部并发症（PPCs）发生率明显较低（46.3%对64.6%；RR，0.72；95% CI，0.61-0.84；P< 0.001）。与 80% FIO2 组相比，30% FIO2 组在术后 7 天内的 PPC 严重程度评分明显降低（P <0.001）。手术结束时，30% FIO2 组的动态顺应性明显更高（56 [48-66] 对 53 [46-62]，P = 0.027）。在 PACU 住院期间，80% FIO2 组中有更多患者在吸入空气时出现氧饱和度降低（SpO2 < 94 %）（18.5 % vs. 30.4 %; RR, 0.61; 95 % CI, 0.44-0.84; P = 0.002; 30 % FIO2 组 vs. 80 % FIO2 组）。结论在腹部开腹手术患者中，与 80% FIO2 相比，在压力引导通气策略的驱动下，术中使用 30% FIO2 可降低术后 7 天内肺部并发症的发生率和严重程度。

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Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: A randomized controlled trial

Study objective

The aim of the present study was to determine the effect of 30 % fraction of inspired oxygen (FIO₂) compared with 80 % FIO₂ in the context of driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery.

Design

A single-center, prospective, randomized controlled trial.

Setting

Tertiary university hospital in China.

Patients

514 adult patients, ASA I-III and scheduled for major open abdominal surgery under general anesthesia.

Interventions

Patients were randomly assigned to receive either 30 % or 80 % FIO₂ during the intraoperative period. All patients received driving pressure-guided ventilation strategy, including low tidal volume and individualized PEEP set at lowest driving pressure.

Measurements

The primary outcome was the incidence of a composite of pulmonary complications within the 7 days postoperatively. The severity of pulmonary complications, extrapulmonary complications, and other secondary outcomes were also assessed.

Main results

Of 1553 patients assessed for eligibility, 514 patients were randomly assigned and analyzed with intention-to-treat principle. Patients receiving 30 % FIO₂ had a significantly lower incidence of postoperative pulmonary complications (PPCs) compared to those receiving 80 % FIO₂ (46.3 %vs. 64.6 %; RR, 0.72; 95 % CI, 0.61–0.84; P < 0.001). The severity score of PPCs was significantly reduced in the 30 % FIO₂ group compared with that in the 80 % FIO₂ group within the 7 postoperative days (P < 0.001). Dynamic compliance was significantly greater in 30 % FIO₂ group at the end of surgery (56 [48–66] vs. 53 [46–62], P = 0.027). More patients in the 80 % FIO₂ group developed oxygen desaturation (SpO₂ < 94 %) on air intake during PACU stay (18.5 %vs. 30.4 %; RR, 0.61; 95 % CI, 0.44–0.84; P = 0.002; 30 % FIO₂ group vs.80 % FIO₂ group).

Conclusions

In patients undergoing open abdominal surgery, using a 30 % FIO₂, compared with 80 % FIO₂, in context of driving pressure-guided ventilation strategy, intraoperatively reduced the incidence and severity of pulmonary complications within the first 7 postoperative days.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.