Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass
-
Hülya Yilmaz AK
,
Yasemin Özşahin
,
Mehmet Ali Yeşiltaş
,
Baris Sandal
,
Ziya Salihoglu
,
Kerem Erkalp
Abstract
Background: In cardiac surgery, supraphysiological oxygen levels are frequently applied perioperatively. In this study, we examined the postoperative effect of perioperative hyperoxemia in cardiac surgery.
Methods: All patients who underwent mitral valve replacement via the standard sternotomy method between 2010 and 2021 were analyzed by scanning the hospital data system. The patients were divided into 2 groups: the hyperoxemic group (partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] > 500 mmHg) (Group I) and the normoxemic group (300 mmHg < PaO2/FiO2 < 500 mmHg) (Group II) according to the mean of 3 PaO2/FiO2 values calculated by using 3 PaO2 and 3 FiO2 levels. Postoperative complications, the mechanical ventilation time, the need for noninvasive mechanical ventilator support, the length of intensive care unit (ICU) stay, the hospitalization period, and the mortality rate of the groups were compared.
Results: A total of 78 patients were included in the study, and 53 of the patients (67.9%) were female. The mean age of the patients was 58.89±12.60 years. The total mechanical ventilation time was significantly higher in the hyperoxemic group than in Group II (P<0.001) (18.18±12.90 h and 11.45±7.85 h, respectively). The amount of postoperative bleeding was significantly higher in Group I (P=0.003) (539.47±201.74 mL and 417.50±186.93 mL, respectively). The total amount of blood products administered during surgery and ICU stay was higher in Group I (P=0.041) (3.55±1.59 units and 2.87±1.89 units, respectively).
Conclusion: We observed that the group with hyperoxemia during cardiopulmonary bypass had a higher amount of postoperative bleeding and the need for transfusion, as well as a longer duration of mechanical ventilation and intensive care.
1. Martin DS, McKenna HT, Morkane CM. Intraoperative hyperoxemia: an unnecessary evil? Anesth Analg 2016;123:1643.
2. Chu DK, Kim LH, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, Szczeklik W, Schünemann HJ, Neary JD, Alhazzani W. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018;391:1693-1705.
3. Rodríguez-González R, Martín-Barrasa JL, Ramos-Nuez Á, Cañas-Pedrosa AM, Martínez-Saavedra MT, García-Bello MÁ, López-Aguilar J, Baluja A, Álvarez J, Slutsky AS, Villar J. Multiple system organ response induced by hyperoxia in a clinically relevant animal model of sepsis. Shock 2014;42:148-153.
4. Heinrichs J, Lodewyks C, Neilson C, Abou-Setta A, Grocott HP. The impact of hyperoxia on outcomes after cardiac surgery: a systematic review and narrative synthesis. Can J Anaesth 2018;65:923-935.
5. Shaefi S, Marcantonio ER, Mueller A, Banner-Goodspeed V, Robson SC, Spear K, Otterbein LE, O'Gara BP, Talmor DS, Subramaniam B. Intraoperative oxygen concentration and neurocognition after cardiac surgery: study protocol for a randomized controlled trial. Trials 2017;18:600.
6. Young RW. Hyperoxia: a review of the risks and benefits in adult cardiac surgery. J Extra Corpor Technol 2012;44:241-249.
7. McGuinness SP, Parke RL, Drummond K, Willcox T, Bailey M, Kruger C, Baker M, Cowdrey KA, Gilder E, McCarthy L, Painter T; SO-COOL investigators. A multicenter, randomized, controlled phase IIb trial of avoidance of hyperoxemia during cardiopulmonary bypass. Anesthesiology 2016;125:465-473.
8. Duclos G, Rivory A, Rességuier N, Hammad E, Vigne C, Meresse Z, Pastène B, D'journo XB, Jaber S, Zieleskiewicz L, Leone M. Effect of early hyperoxemia on the outcome in severe blunt chest trauma: a propensity score-based analysis of a single-center retrospective cohort. J Crit Care 2021;63:179-186.
9. Reidy BTG, Whyte P, Neligan PJ. Is oxygen toxic? In: Deutschman CS, Neligan PJ, eds. Evidence-Based Practice of Critical Care. 3rd ed. Philadelphia: Elsevier; 2020. p. 36-42.
10. Horovitz JH, Carrico CJ, Shires GT. Pulmonary response to major injury. Arch Surg 1974;108:349-355.
11. Karbing DS, Kjaergaard S, Smith BW, Espersen K, Allerød C, Andreassen S, Rees SE. Variation in the PaO2/FiO2 ratio with FiO2: mathematical and experimental description, and clinical relevance. Crit Care 2007;11:R118.
12. Pourhoseingholi MA, Baghestani AR, Vahedi M. How to control confounding effects by statistical analysis. Gastroenterol Hepatol Bed Bench 2012;5:79-83.
13. Smith JL. The pathological effects due to increase of oxygen tension in the air breathed. J Physiol 1899;24:19-35.
14. Crawford TC, Magruder JT, Grimm JC, Kemp CD, Suarez-Pierre A, Zehr KJ, Mandal K, Whitman GJ, Conte JV, Higgins RS, Cameron DE, Sciortino CM. The paradoxical relationship between donor distance and survival after heart transplantation. Ann Thorac Surg 2017;103:1384-1391.
15. Eisner MD, Thompson T, Hudson LD, Luce JM, Hayden D, Schoenfeld D, Matthay MA; Acute Respiratory Distress Syndrome Network. Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med 2001;164:231-236.
16. Jakutis G, Norkienė I, Ringaitienė D, Jovaiša T. Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery. Acta Med Litu 2017;24:153-158.
17. Lee JS, Kim JC, Chung JY, Hong SW, Choi KH, Kwak YL. Effect of arterial oxygen tension during reperfusion on myocardial recovery in patients undergoing valvular heart surgery. Korean J Anesthesiol 2010;58:122-128.
18. Smit B, Smulders YM, de Waard MC, Boer C, Vonk AB, Veerhoek D, Kamminga S, de Grooth HJ, García-Vallejo JJ, Musters RJ, Girbes AR, Oudemans-van Straaten HM, Spoelstra-de Man AM. Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial. Crit Care 2016;20:55.
19. Toraman F, Evrenkaya S, Senay S, Karabulut H, Alhan C. Adjusting oxygen fraction to avoid hyperoxemia during cardiopulmonary bypass. Asian Cardiovasc Thorac Ann 2007;15:303-306.
20. Wenk M, Van Aken H, Zarbock A. The new World Health Organization recommendations on perioperative administration of oxygen to prevent surgical site infections: a dangerous reductionist approach? Anesth Analg 2017;125:682-687.
21. Greif R, Akça O, Horn EP, Kurz A, Sessler DI; Outcomes Research Group. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 2000;342:161-167.
22. Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Piccione F, Amicucci G. Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration: a prospective randomized, double-blind, controlled, single-center trial. Ann Surg Oncol 2013;20:1584-1590.
23. Stall A, Paryavi E, Gupta R, Zadnik M, Hui E, O'Toole RV. Perioperative supplemental oxygen to reduce surgical site infection after open fixation of high-risk fractures: a randomized controlled pilot trial. J Trauma Acute Care Surg 2013;75:657-663.
24. Pryor KO, Fahey TJ, 3rd, Lien CA, Goldstein PA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 2004;291:79-87.
25. Garcia-Alvarez M, Marik P, Bellomo R. Stress hyperlactataemia: present understanding and controversy. Lancet Diabetes Endocrinol 2014;2:339-347.
26. Sevuk U, Altindag R, Baysal E, Yaylak B, Adiyaman MS, Akkaya S, Ay N, Alp V. The effects of hyperoxaemia on tissue oxygenation in patients with a nadir haematocrit lower than 20% during cardiopulmonary bypass. Perfusion 2016;31:232-239.
27. Thomson AJ, Drummond GB, Waring WS, Webb DJ, Maxwell SR. Effects of short-term isocapnic hyperoxia and hypoxia on cardiovascular function. J Appl Physiol (1985) 2006;101:809-816.
28. Mak S, Azevedo ER, Liu PP, Newton GE. Effect of hyperoxia on left ventricular function and filling pressures in patients with and without congestive heart failure. Chest 2001;120:467-473.
29. Guensch DP, Fischer K, Yamaji K, Luescher S, Ueki Y, Jung B, Erdoes G, Gräni C, von Tengg-Kobligk H, Räber L, Eberle B. Effect of hyperoxia on myocardial oxygenation and function in patients with stable multivessel coronary artery disease. J Am Heart Assoc 2020;9:e014739.
30. Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ, Meredith IT, Kaye DM; AVOID Investigators. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 2015;131:2143-2150.
31. Inoue T, Ku K, Kaneda T, Zang Z, Otaki M, Oku H. Cardioprotective effects of lowering oxygen tension after aortic unclamping on cardiopulmonary bypass during coronary artery bypass grafting. Circ J 2002;66:718-722.
32. Peterson ED, Coombs LP, Ferguson TB, Shroyer AL, DeLong ER, Grover FL, Edwards FH. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon's National Cardiac Database. Ann Thorac Surg 2002;74:464-473.
33. Sutton AD, Bailey M, Bellomo R, Eastwood GM, Pilcher DV. The association between early arterial oxygenation in the ICU and mortality following cardiac surgery. Anaesth Intensive Care 2014;42:730-735.
34. Joachimsson PO, Sjöberg F, Forsman M, Johansson M, Ahn HC, Rutberg H. Adverse effects of hyperoxemia during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1996;112:812-819.
35. Halter M, Jouffroy R, Saade A, Philippe P, Carli P, Vivien B. Association between hyperoxemia and mortality in patients treated by eCPR after out-of-hospital cardiac arrest. Am J Emerg Med 2020;38:900-905.
36. de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, Bosman RJ, de Waal RA, Wesselink R, de Keizer NF. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care 2008;12:R156.
37. Eastwood G, Bellomo R, Bailey M, Taori G, Pilcher D, Young P, Beasley R. Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Med 2012;38:91-98.
38. Page D, Ablordeppey E, Wessman BT, Mohr NM, Trzeciak S, Kollef MH, Roberts BW, Fuller BM. Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study. Crit Care 2018;22:9.
39. Sattartabar B, Ajam A, Pashang M, Jalali A, Sadeghian S, Mortazavi H, Mansourian S, Bagheri J, Karimi AA, Hosseini K. Sex and age difference in risk factor distribution, trend, and long-term outcome of patients undergoing isolated coronary artery bypass graft surgery. BMC Cardiovasc Disord 2021;21:460.
40. Hosseini K, Yavari N, Pashang M, Jalali A, Nalini M, Majdi Nassab F, Sadeghian S, Salehi Omran A, Bagheri J, Poorhosseini H, Salarifar M, Ahmadi Tafti SH, Tajdini M. Sex difference in the risk factor distributions and outcomes after coronary artery bypass graft surgery in the young population. Eur J Cardiothorac Surg 2021:ezab475.
2. Chu DK, Kim LH, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, Szczeklik W, Schünemann HJ, Neary JD, Alhazzani W. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018;391:1693-1705.
3. Rodríguez-González R, Martín-Barrasa JL, Ramos-Nuez Á, Cañas-Pedrosa AM, Martínez-Saavedra MT, García-Bello MÁ, López-Aguilar J, Baluja A, Álvarez J, Slutsky AS, Villar J. Multiple system organ response induced by hyperoxia in a clinically relevant animal model of sepsis. Shock 2014;42:148-153.
4. Heinrichs J, Lodewyks C, Neilson C, Abou-Setta A, Grocott HP. The impact of hyperoxia on outcomes after cardiac surgery: a systematic review and narrative synthesis. Can J Anaesth 2018;65:923-935.
5. Shaefi S, Marcantonio ER, Mueller A, Banner-Goodspeed V, Robson SC, Spear K, Otterbein LE, O'Gara BP, Talmor DS, Subramaniam B. Intraoperative oxygen concentration and neurocognition after cardiac surgery: study protocol for a randomized controlled trial. Trials 2017;18:600.
6. Young RW. Hyperoxia: a review of the risks and benefits in adult cardiac surgery. J Extra Corpor Technol 2012;44:241-249.
7. McGuinness SP, Parke RL, Drummond K, Willcox T, Bailey M, Kruger C, Baker M, Cowdrey KA, Gilder E, McCarthy L, Painter T; SO-COOL investigators. A multicenter, randomized, controlled phase IIb trial of avoidance of hyperoxemia during cardiopulmonary bypass. Anesthesiology 2016;125:465-473.
8. Duclos G, Rivory A, Rességuier N, Hammad E, Vigne C, Meresse Z, Pastène B, D'journo XB, Jaber S, Zieleskiewicz L, Leone M. Effect of early hyperoxemia on the outcome in severe blunt chest trauma: a propensity score-based analysis of a single-center retrospective cohort. J Crit Care 2021;63:179-186.
9. Reidy BTG, Whyte P, Neligan PJ. Is oxygen toxic? In: Deutschman CS, Neligan PJ, eds. Evidence-Based Practice of Critical Care. 3rd ed. Philadelphia: Elsevier; 2020. p. 36-42.
10. Horovitz JH, Carrico CJ, Shires GT. Pulmonary response to major injury. Arch Surg 1974;108:349-355.
11. Karbing DS, Kjaergaard S, Smith BW, Espersen K, Allerød C, Andreassen S, Rees SE. Variation in the PaO2/FiO2 ratio with FiO2: mathematical and experimental description, and clinical relevance. Crit Care 2007;11:R118.
12. Pourhoseingholi MA, Baghestani AR, Vahedi M. How to control confounding effects by statistical analysis. Gastroenterol Hepatol Bed Bench 2012;5:79-83.
13. Smith JL. The pathological effects due to increase of oxygen tension in the air breathed. J Physiol 1899;24:19-35.
14. Crawford TC, Magruder JT, Grimm JC, Kemp CD, Suarez-Pierre A, Zehr KJ, Mandal K, Whitman GJ, Conte JV, Higgins RS, Cameron DE, Sciortino CM. The paradoxical relationship between donor distance and survival after heart transplantation. Ann Thorac Surg 2017;103:1384-1391.
15. Eisner MD, Thompson T, Hudson LD, Luce JM, Hayden D, Schoenfeld D, Matthay MA; Acute Respiratory Distress Syndrome Network. Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med 2001;164:231-236.
16. Jakutis G, Norkienė I, Ringaitienė D, Jovaiša T. Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery. Acta Med Litu 2017;24:153-158.
17. Lee JS, Kim JC, Chung JY, Hong SW, Choi KH, Kwak YL. Effect of arterial oxygen tension during reperfusion on myocardial recovery in patients undergoing valvular heart surgery. Korean J Anesthesiol 2010;58:122-128.
18. Smit B, Smulders YM, de Waard MC, Boer C, Vonk AB, Veerhoek D, Kamminga S, de Grooth HJ, García-Vallejo JJ, Musters RJ, Girbes AR, Oudemans-van Straaten HM, Spoelstra-de Man AM. Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial. Crit Care 2016;20:55.
19. Toraman F, Evrenkaya S, Senay S, Karabulut H, Alhan C. Adjusting oxygen fraction to avoid hyperoxemia during cardiopulmonary bypass. Asian Cardiovasc Thorac Ann 2007;15:303-306.
20. Wenk M, Van Aken H, Zarbock A. The new World Health Organization recommendations on perioperative administration of oxygen to prevent surgical site infections: a dangerous reductionist approach? Anesth Analg 2017;125:682-687.
21. Greif R, Akça O, Horn EP, Kurz A, Sessler DI; Outcomes Research Group. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 2000;342:161-167.
22. Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Piccione F, Amicucci G. Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration: a prospective randomized, double-blind, controlled, single-center trial. Ann Surg Oncol 2013;20:1584-1590.
23. Stall A, Paryavi E, Gupta R, Zadnik M, Hui E, O'Toole RV. Perioperative supplemental oxygen to reduce surgical site infection after open fixation of high-risk fractures: a randomized controlled pilot trial. J Trauma Acute Care Surg 2013;75:657-663.
24. Pryor KO, Fahey TJ, 3rd, Lien CA, Goldstein PA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 2004;291:79-87.
25. Garcia-Alvarez M, Marik P, Bellomo R. Stress hyperlactataemia: present understanding and controversy. Lancet Diabetes Endocrinol 2014;2:339-347.
26. Sevuk U, Altindag R, Baysal E, Yaylak B, Adiyaman MS, Akkaya S, Ay N, Alp V. The effects of hyperoxaemia on tissue oxygenation in patients with a nadir haematocrit lower than 20% during cardiopulmonary bypass. Perfusion 2016;31:232-239.
27. Thomson AJ, Drummond GB, Waring WS, Webb DJ, Maxwell SR. Effects of short-term isocapnic hyperoxia and hypoxia on cardiovascular function. J Appl Physiol (1985) 2006;101:809-816.
28. Mak S, Azevedo ER, Liu PP, Newton GE. Effect of hyperoxia on left ventricular function and filling pressures in patients with and without congestive heart failure. Chest 2001;120:467-473.
29. Guensch DP, Fischer K, Yamaji K, Luescher S, Ueki Y, Jung B, Erdoes G, Gräni C, von Tengg-Kobligk H, Räber L, Eberle B. Effect of hyperoxia on myocardial oxygenation and function in patients with stable multivessel coronary artery disease. J Am Heart Assoc 2020;9:e014739.
30. Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ, Meredith IT, Kaye DM; AVOID Investigators. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 2015;131:2143-2150.
31. Inoue T, Ku K, Kaneda T, Zang Z, Otaki M, Oku H. Cardioprotective effects of lowering oxygen tension after aortic unclamping on cardiopulmonary bypass during coronary artery bypass grafting. Circ J 2002;66:718-722.
32. Peterson ED, Coombs LP, Ferguson TB, Shroyer AL, DeLong ER, Grover FL, Edwards FH. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon's National Cardiac Database. Ann Thorac Surg 2002;74:464-473.
33. Sutton AD, Bailey M, Bellomo R, Eastwood GM, Pilcher DV. The association between early arterial oxygenation in the ICU and mortality following cardiac surgery. Anaesth Intensive Care 2014;42:730-735.
34. Joachimsson PO, Sjöberg F, Forsman M, Johansson M, Ahn HC, Rutberg H. Adverse effects of hyperoxemia during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1996;112:812-819.
35. Halter M, Jouffroy R, Saade A, Philippe P, Carli P, Vivien B. Association between hyperoxemia and mortality in patients treated by eCPR after out-of-hospital cardiac arrest. Am J Emerg Med 2020;38:900-905.
36. de Jonge E, Peelen L, Keijzers PJ, Joore H, de Lange D, van der Voort PH, Bosman RJ, de Waal RA, Wesselink R, de Keizer NF. Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care 2008;12:R156.
37. Eastwood G, Bellomo R, Bailey M, Taori G, Pilcher D, Young P, Beasley R. Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Med 2012;38:91-98.
38. Page D, Ablordeppey E, Wessman BT, Mohr NM, Trzeciak S, Kollef MH, Roberts BW, Fuller BM. Emergency department hyperoxia is associated with increased mortality in mechanically ventilated patients: a cohort study. Crit Care 2018;22:9.
39. Sattartabar B, Ajam A, Pashang M, Jalali A, Sadeghian S, Mortazavi H, Mansourian S, Bagheri J, Karimi AA, Hosseini K. Sex and age difference in risk factor distribution, trend, and long-term outcome of patients undergoing isolated coronary artery bypass graft surgery. BMC Cardiovasc Disord 2021;21:460.
40. Hosseini K, Yavari N, Pashang M, Jalali A, Nalini M, Majdi Nassab F, Sadeghian S, Salehi Omran A, Bagheri J, Poorhosseini H, Salarifar M, Ahmadi Tafti SH, Tajdini M. Sex difference in the risk factor distributions and outcomes after coronary artery bypass graft surgery in the young population. Eur J Cardiothorac Surg 2021:ezab475.
| Files | ||
| Issue | Vol 17 No 2 (2022): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v17i2.9834 | |
| Keywords | ||
| Oxygen Cardiopulmonary bypass Morbidity Mortality | ||
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How to Cite
1.
Yilmaz AK H, Özşahin Y, Yeşiltaş M, Sandal B, Salihoglu Z, Erkalp K. Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass. J Tehran Heart Cent. 2022;17(2):41-47.
