{"title":"评估心脏手术后肥胖患者高氧诱导的高碳酸血症：保守和宽松给氧的随机交叉比较。","authors":"Marie-Hélène Denault, Carolanne Ruel, Mathieu Simon, Pierre-Alexandre Bouchard, Serge Simard, François Lellouche","doi":"10.1007/s12630-019-01500-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Recent studies on patients with stable obesity-hypoventilation syndrome have raised concerns about hyperoxia-induced hypercapnia in this population. This study aimed to evaluate whether a higher oxygen saturation target would increase arterial partial pressure of carbon dioxide (PaCO<sub>2)</sub> in obese patients after coronary artery bypass grafting surgery (CABG).</p><p><strong>Methods: </strong>Obese patients having CABG were recruited. With a randomized crossover design, we compared two oxygenation strategies for 30 min each, immediately after extubation: a peripheral oxygen saturation (SpO<sub>2</sub>) target of ≥ 95% achieved with manual oxygen titration (liberal) and a SpO<sub>2</sub> target of 90% achieved with FreeO<sub>2</sub>, an automated oxygen titration device (conservative). The main outcome was end-of-period arterial PaCO<sub>2</sub>.</p><p><strong>Results: </strong>Thirty patients were included. Mean (standard deviation [SD]) body mass index (BMI) was 34 (3) kg·m<sup>-2</sup> and mean (SD) baseline partial pressure of carbon dioxide (PCO<sub>2</sub>) was 40.7 (3.1) mmHg. Mean (SD) end-of-period PaCO<sub>2</sub> was 42.0 (5.4) mmHg in the conservative period, compared with 42.6 (4.6) mmHg in the liberal period [mean difference - 0.6 (95% confidence interval - 2.2 to 0.9) mmHg; P = 0.4]. Adjusted analysis for age, BMI, narcotics, and preoperative PaCO<sub>2</sub> did not substantively change the results. Fourteen patients were retainers, showing an elevation in mean (SD) PaCO<sub>2</sub> in the liberal period of 3.3 (4.1) mmHg. Eleven patients had the opposite response, with a mean (SD) end-of-period PaCO<sub>2</sub> decrease of 1.8 (2.2) mmHg in the liberal period. Five patients had a neutral response.</p><p><strong>Conclusion: </strong>This study did not show a clinically important increase in PaCO<sub>2</sub> associated with higher SpO<sub>2</sub> values in this specific population of obese patients after CABG. Partial pressure of carbon dioxide increased with liberal oxygen administration in almost half of the patients, but no predictive factor was identified.</p><p><strong>Trial registration: </strong>www.clinicaltrials.gov (NCT02917668); registered 25 September, 2016.</p>","PeriodicalId":44199,"journal":{"name":"ENGLISH LITERARY RENAISSANCE","volume":"35 1","pages":"194-202"},"PeriodicalIF":0.6000,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s12630-019-01500-x","citationCount":"2","resultStr":"{\"title\":\"Evaluation of hyperoxia-induced hypercapnia in obese patients after cardiac surgery: a randomized crossover comparison of conservative and liberal oxygen administration.\",\"authors\":\"Marie-Hélène Denault, Carolanne Ruel, Mathieu Simon, Pierre-Alexandre Bouchard, Serge Simard, François Lellouche\",\"doi\":\"10.1007/s12630-019-01500-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Recent studies on patients with stable obesity-hypoventilation syndrome have raised concerns about hyperoxia-induced hypercapnia in this population. This study aimed to evaluate whether a higher oxygen saturation target would increase arterial partial pressure of carbon dioxide (PaCO<sub>2)</sub> in obese patients after coronary artery bypass grafting surgery (CABG).</p><p><strong>Methods: </strong>Obese patients having CABG were recruited. With a randomized crossover design, we compared two oxygenation strategies for 30 min each, immediately after extubation: a peripheral oxygen saturation (SpO<sub>2</sub>) target of ≥ 95% achieved with manual oxygen titration (liberal) and a SpO<sub>2</sub> target of 90% achieved with FreeO<sub>2</sub>, an automated oxygen titration device (conservative). The main outcome was end-of-period arterial PaCO<sub>2</sub>.</p><p><strong>Results: </strong>Thirty patients were included. Mean (standard deviation [SD]) body mass index (BMI) was 34 (3) kg·m<sup>-2</sup> and mean (SD) baseline partial pressure of carbon dioxide (PCO<sub>2</sub>) was 40.7 (3.1) mmHg. Mean (SD) end-of-period PaCO<sub>2</sub> was 42.0 (5.4) mmHg in the conservative period, compared with 42.6 (4.6) mmHg in the liberal period [mean difference - 0.6 (95% confidence interval - 2.2 to 0.9) mmHg; P = 0.4]. Adjusted analysis for age, BMI, narcotics, and preoperative PaCO<sub>2</sub> did not substantively change the results. Fourteen patients were retainers, showing an elevation in mean (SD) PaCO<sub>2</sub> in the liberal period of 3.3 (4.1) mmHg. Eleven patients had the opposite response, with a mean (SD) end-of-period PaCO<sub>2</sub> decrease of 1.8 (2.2) mmHg in the liberal period. Five patients had a neutral response.</p><p><strong>Conclusion: </strong>This study did not show a clinically important increase in PaCO<sub>2</sub> associated with higher SpO<sub>2</sub> values in this specific population of obese patients after CABG. Partial pressure of carbon dioxide increased with liberal oxygen administration in almost half of the patients, but no predictive factor was identified.</p><p><strong>Trial registration: </strong>www.clinicaltrials.gov (NCT02917668); registered 25 September, 2016.</p>\",\"PeriodicalId\":44199,\"journal\":{\"name\":\"ENGLISH LITERARY RENAISSANCE\",\"volume\":\"35 1\",\"pages\":\"194-202\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2020-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1007/s12630-019-01500-x\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ENGLISH LITERARY RENAISSANCE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12630-019-01500-x\",\"RegionNum\":2,\"RegionCategory\":\"文学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2019/10/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"0\",\"JCRName\":\"LITERATURE, BRITISH ISLES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ENGLISH LITERARY RENAISSANCE","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12630-019-01500-x","RegionNum":2,"RegionCategory":"文学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2019/10/24 0:00:00","PubModel":"Epub","JCR":"0","JCRName":"LITERATURE, BRITISH ISLES","Score":null,"Total":0}
Evaluation of hyperoxia-induced hypercapnia in obese patients after cardiac surgery: a randomized crossover comparison of conservative and liberal oxygen administration.
Purpose: Recent studies on patients with stable obesity-hypoventilation syndrome have raised concerns about hyperoxia-induced hypercapnia in this population. This study aimed to evaluate whether a higher oxygen saturation target would increase arterial partial pressure of carbon dioxide (PaCO2) in obese patients after coronary artery bypass grafting surgery (CABG).
Methods: Obese patients having CABG were recruited. With a randomized crossover design, we compared two oxygenation strategies for 30 min each, immediately after extubation: a peripheral oxygen saturation (SpO2) target of ≥ 95% achieved with manual oxygen titration (liberal) and a SpO2 target of 90% achieved with FreeO2, an automated oxygen titration device (conservative). The main outcome was end-of-period arterial PaCO2.
Results: Thirty patients were included. Mean (standard deviation [SD]) body mass index (BMI) was 34 (3) kg·m-2 and mean (SD) baseline partial pressure of carbon dioxide (PCO2) was 40.7 (3.1) mmHg. Mean (SD) end-of-period PaCO2 was 42.0 (5.4) mmHg in the conservative period, compared with 42.6 (4.6) mmHg in the liberal period [mean difference - 0.6 (95% confidence interval - 2.2 to 0.9) mmHg; P = 0.4]. Adjusted analysis for age, BMI, narcotics, and preoperative PaCO2 did not substantively change the results. Fourteen patients were retainers, showing an elevation in mean (SD) PaCO2 in the liberal period of 3.3 (4.1) mmHg. Eleven patients had the opposite response, with a mean (SD) end-of-period PaCO2 decrease of 1.8 (2.2) mmHg in the liberal period. Five patients had a neutral response.
Conclusion: This study did not show a clinically important increase in PaCO2 associated with higher SpO2 values in this specific population of obese patients after CABG. Partial pressure of carbon dioxide increased with liberal oxygen administration in almost half of the patients, but no predictive factor was identified.
期刊介绍：
English Literary Renaissance is a journal devoted to current criticism and scholarship of Tudor and early Stuart English literature, 1485-1665, including Shakespeare, Spenser, Donne, and Milton. It is unique in featuring the publication of rare texts and newly discovered manuscripts of the period and current annotated bibliographies of work in the field. It is illustrated with contemporary woodcuts and engravings of Renaissance England and Europe.
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