Con: Hyperoxia Should Not Be Used Routinely in the Management of Cardiopulmonary Bypass

Roberts, S. Michael; Cios, Theodore J.

doi:10.1053/j.jvca.2019.02.027

Cited by 8 publications

(4 citation statements)

References 46 publications

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“…Moreover, it is generally accepted that above a certain level, manipulating FiO 2 has little effect on DO 2 [ 8 ]. Consequently, using high levels of supplemental oxygen during surgery is controversially discussed [ 9 , 10 ]. However, evidence regarding the optimal perioperative FiO 2 is insufficient and inconsistent [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of intraoperative inspired oxygen fraction (FiO2 0.3 vs 0.8) on patients undergoing off-pump coronary artery bypass grafting: the CARROT multicenter, cluster-randomized trial

Nam

Kim

et al. 2023

Crit Care

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Background To maintain adequate oxygenation is of utmost importance in intraoperative care. However, clinical evidence supporting specific oxygen levels in distinct surgical settings is lacking. This study aimed to compare the effects of 30% and 80% oxygen in off-pump coronary artery bypass grafting (OPCAB). Methods This multicenter trial was conducted in three tertiary hospitals from August 2019 to August 2021. Patients undergoing OPCAB were cluster-randomized to receive either 30% or 80% oxygen intraoperatively, based on the month when the surgery was performed. The primary endpoint was the length of hospital stay. Intraoperative hemodynamic data were also compared. Results A total of 414 patients were cluster-randomized. Length of hospital stay was not different in the 30% oxygen group compared to the 80% oxygen group (median, 7.0 days vs 7.0 days; the sub-distribution hazard ratio, 0.98; 95% confidence interval [CI] 0.83–1.16; P = 0.808). The incidence of postoperative acute kidney injury was significantly higher in the 30% oxygen group than in the 80% oxygen group (30.7% vs 19.4%; odds ratio, 1.94; 95% CI 1.18–3.17; P = 0.036). Intraoperative time-weighted average mixed venous oxygen saturation was significantly higher in the 80% oxygen group (74% vs 64%; P < 0.001). The 80% oxygen group also had a significantly greater intraoperative time-weighted average cerebral regional oxygen saturation than the 30% oxygen group (56% vs 52%; P = 0.002). Conclusions In patients undergoing OPCAB, intraoperative administration of 80% oxygen did not decrease the length of hospital stay, compared to 30% oxygen, but may reduce postoperative acute kidney injury. Moreover, compared to 30% oxygen, intraoperative use of 80% oxygen improved oxygen delivery in patients undergoing OPCAB. Trial registration ClinicalTrials.gov (NCT03945565; April 8, 2019).

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Section: Introductionmentioning

confidence: 99%

Effects of intraoperative inspired oxygen fraction (FiO2 0.3 vs 0.8) on patients undergoing off-pump coronary artery bypass grafting: the CARROT multicenter, cluster-randomized trial

Nam

Kim

et al. 2023

Crit Care

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“…Experts in cardiac anesthesiology remain divided regarding the use of hyperoxia during cardiac surgery. 13,14 Although recent data support avoiding hyperoxia in most critically ill patients, the lack of high-quality studies specific to cardiac surgery represents a critical gap in the field. Two well-designed clinical trials from the past year addressed this gap by providing additional data.…”

Section: Introductionmentioning

confidence: 99%

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Smoroda

Douin

Morabito

et al. 2022

Semin Cardiothorac Vasc Anesth

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In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: “cardiac anesthesiology and outcomes” (n = 177), “cardiothoracic anesthesiology” (n = 34), “cardiac anesthesia,” and “clinical outcomes” (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.

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“…Moreover, recently published guidelines on CPB in adult cardiac surgery recommend that "PEEP during CPB should be considered in order to protect the lungs" and "Ventilation during CPB may be considered for lung protection" (level of evidence B) [ 9 ]. In addition, the arguments both for and against the use of hyperoxia in cardiac surgery are still ongoing [ 10 , 11 ]. However, the effect of low V T ventilation with different FiO 2 during CPB in patients having cardiac surgery is still unclear.…”

Section: Introductionmentioning

confidence: 99%

Effect of ventilation strategy during cardiopulmonary bypass on postoperative pulmonary complications after cardiac surgery: a randomized clinical trial

Zhang

Liao

et al. 2021

J Cardiothorac Surg

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Background To determine whether maintaining ventilation during cardiopulmonary bypass (CPB) with a different fraction of inspired oxygen (FiO2) had an impact on the occurrence of postoperative pulmonary complications (PPCs). Methods A total of 413 adult patients undergoing elective cardiac surgery with CPB were randomly assigned into three groups: 138 in the NoV group (received no mechanical ventilation during CPB), 138 in the LOV group (received a tidal volume (VT) of 3–4 ml/kg of ideal body weight with the respiratory rate of 10–12 bpm, and the positive end-expiratory pressure of 5–8 cmH2O during CPB; the FiO2 was 30%), and 137 in the HOV group (received the same ventilation parameters settings as the LOV group while the FiO2 was 80%). Results The primary outcomes were the incidence and severity of PPCs during hospitalization. The composite incidence of PPCs did not significantly differ between the NoV (63%), LOV (49%) and HOV (57%) groups (P = 0.069). And there was also no difference regarding the incidence of PPCs between the non-ventilation (NoV) and ventilation (the combination of LOV and HOV) groups. The LOV group was observed a lower proportion of moderate and severe pulmonary complications (grade ≥ 3) than the NoV group (23.1% vs. 44.2%, P = 0.001). Conclusion Maintaining ventilation during CPB did not reduce the incidence of PPCs in patients undergoing cardiac surgery. Trial registration: Chinese Clinical Trial Registry ChiCTR1800015261. Prospectively registered 19 March 2018. http://www.chictr.org.cn/showproj.aspx?proj=25982

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Con: Hyperoxia Should Not Be Used Routinely in the Management of Cardiopulmonary Bypass

Cited by 8 publications

References 46 publications

Effects of intraoperative inspired oxygen fraction (FiO2 0.3 vs 0.8) on patients undergoing off-pump coronary artery bypass grafting: the CARROT multicenter, cluster-randomized trial

Effects of intraoperative inspired oxygen fraction (FiO2 0.3 vs 0.8) on patients undergoing off-pump coronary artery bypass grafting: the CARROT multicenter, cluster-randomized trial

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Effect of ventilation strategy during cardiopulmonary bypass on postoperative pulmonary complications after cardiac surgery: a randomized clinical trial

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