Intraoperative oxygenation in adult patients undergoing surgery (iOPS): a retrospective observational study across 29 UK hospitals

Morkane, Clare; McKenna, Helen; Cumpstey, Andrew F.; Oldman, Alex H.; Grocott, Michael P.W.; Martin, Daniel

doi:10.1186/s13741-018-0098-3

Cited by 32 publications

(25 citation statements)

References 23 publications

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“…Furthermore, this variability is linked to clinical outcomes . Similar patterns of variation in care pertain in peri‐operative blood transfusion , oxygen therapy and peri‐operative ventilation . These observations support the notion that intra‐operative care should be both standardised and individualised; standardised to drive consistent patterns of care between different patients, and individualised to ensure that such care is based on individual patients’ clinical risk.…”

Section: Peri‐operative Care Pathwayssupporting

confidence: 57%

Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’

et al. 2019

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Elective surgical pathways offer a particular opportunity to plan radical change in the way care is delivered, based on patient need rather than provider convenience. Peri-operative pathway redesign enables improved patient experience of care (including quality and satisfaction), population/public health, and healthcare value (outcome per unit of currency). Among physicians with the skills to work within peri-operative medicine, anaesthetists are well positioned to lead the re-engineering of such pathways. Re-engineered pre-operative pathways open up opportunities for intervention before surgery including shared decision-making, comorbidity management and collaborative behavioural change. Individualised, risk-adapted, intra-operative interventions will drive more reliable and consistent care. Risk-adapted postoperative care, particularly around transitions of care, has a significant role in improving value through peri-operative medicine. Improved integration with primary care providers offers the potential for minimising errors around transitions of care before and after surgery, as well as maximising opportunities for population health interventions, including lifestyle modification (e.g. activity/exercise, smoking and/or alcohol cessation), pain management and sleep medicine. Systematic data collection focused on quality improvement is essential to drive continuous clinical improvement and will be enabled by technological development in predictive analytics, systems modelling and artificial intelligence.

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Section: Peri‐operative Care Pathwayssupporting

confidence: 57%

Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’

et al. 2019

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“…Moreover, while routine supplemental oxygen administration is not recommended for non-hypoxemic patients with several acute conditions, such as acute coronary syndrome [ 1 , 2 ] and stroke [ 3 , 4 ], the postoperative period is one of the few circumstances where high-dose oxygen therapy has been recommended to reduce surgical site infections (SSIs) [ 5 ]. However, such recommendations remain controversial and have not been widely accepted in actual clinical practice [ 6 – 8 ]. The present paper therefore reviews the rationale, clinical significance, and controversies regarding postoperative oxygen therapy and re-evaluates the optimal use of postoperative oxygen.…”

Section: Introductionmentioning

confidence: 99%

Oxygen administration for postoperative surgical patients: a narrative review

Suzuki

2020

j intensive care

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Most postoperative surgical patients routinely receive supplemental oxygen therapy to prevent the potential development of hypoxemia due to incomplete lung re-expansion, reduced chest wall, and diaphragmatic activity caused by surgical site pain, consequences of hemodynamic impairment, and residual effects of anesthetic drugs (most notably residual neuromuscular blockade), which may result in atelectasis, ventilation–perfusion mismatch, alveolar hypoventilation, and impaired upper airway patency. Additionally, the World Health Organization guidelines for reducing surgical site infection have recommended the perioperative administration of high-dose oxygen, including during the immediate postoperative period. However, supplemental oxygen and hyperoxemia also have harmful effects on the respiratory and cardiovascular systems, with several clinical studies having reported an association between high perioperative oxygen administration and worse clinical outcomes. Recently, the increased availability of new and short-acting anesthetic drugs, comprehensive pharmacological knowledge, postoperative multimodal analgesia, and new minimally invasive surgery options could result in lower incidences of postoperative hypoxemia. Moreover, recommendations promoting high oxygen administration to prevent surgical site infections have been challenged, considering the lack of scientific investigations, and have not been widely accepted. Given the potential harmful effects of hyperoxemia, routine postoperative oxygen administration might not be recommended. Recent clinical studies have indicated that a conservative approach to oxygen therapy, where oxygen administration is titrated to achieve slightly lower oxygen levels than usual, could be safely implemented and decrease acutely ill patients’ susceptibility to hyperoxemia. Based on current evidence, appropriate monitoring, including peripheral oxygen saturation, and oxygen titration should be required during postoperative oxygen administration to avoid both hypoxemia and hyperoxemia. Future trials should therefore focus on determining the optimal oxygen target during postoperative care.

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“…In brief, the reference patients had undergone recent induction of anesthesia with intravenous opiates (usually fentanyl) and propofol, muscle relaxation using atracurium or rocuronium, and placement of an endotracheal tube for mechanical ventilation and maintenance of anesthesia with volatile agents such as isoflurane, sevoflurane or desflurane. An audit carried out at the Royal Free Hospital, along with 28 other hospitals in England, during the time of the study, demonstrated the administration of a consistent fractional concentration of oxygen of 0.5 throughout surgery, which corresponded to a measured mean partial pressure of oxygen (PaO2) of 25 kPa in patients with an arterial catheter [ 61 ]. All elective surgical patients had fasted for at least 6 h prior to induction of general anesthetic.…”

Section: Methodsmentioning

confidence: 99%

Divergent trajectories of cellular bioenergetics, intermediary metabolism and systemic redox status in survivors and non-survivors of critical illness

et al. 2021

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Background Numerous pathologies result in multiple-organ failure, which is thought to be a direct consequence of compromised cellular bioenergetic status. Neither the nature of this phenotype nor its relevance to survival are well understood, limiting the efficacy of modern life-support. Methods To explore the hypothesis that survival from critical illness relates to changes in cellular bioenergetics, we combined assessment of mitochondrial respiration with metabolomic, lipidomic and redox profiling in skeletal muscle and blood, at multiple timepoints, in 21 critically ill patients and 12 reference patients. Results We demonstrate an end-organ cellular phenotype in critical illness, characterized by preserved total energetic capacity, greater coupling efficiency and selectively lower capacity for complex I and fatty acid oxidation (FAO)-supported respiration in skeletal muscle, compared to health. In survivors, complex I capacity at 48 h was 27% lower than in non-survivors (p = 0.01), but tended to increase by day 7, with no such recovery observed in non-survivors. By day 7, survivors’ FAO enzyme activity was double that of non-survivors (p = 0.048), in whom plasma triacylglycerol accumulated. Increases in both cellular oxidative stress and reductive drive were evident in early critical illness compared to health. Initially, non-survivors demonstrated greater plasma total antioxidant capacity but ultimately higher lipid peroxidation compared to survivors. These alterations were mirrored by greater levels of circulating total free thiol and nitrosated species, consistent with greater reductive stress and vascular inflammation, in non-survivors compared to survivors. In contrast, no clear differences in systemic inflammatory markers were observed between the two groups. Conclusion Critical illness is associated with rapid, specific and coordinated alterations in the cellular respiratory machinery, intermediary metabolism and redox response, with different trajectories in survivors and non-survivors. Unravelling the cellular and molecular foundation of human resilience may enable the development of more effective life-support strategies.

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Intraoperative oxygenation in adult patients undergoing surgery (iOPS): a retrospective observational study across 29 UK hospitals

Cited by 32 publications

References 23 publications

Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’

Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’

Oxygen administration for postoperative surgical patients: a narrative review

Divergent trajectories of cellular bioenergetics, intermediary metabolism and systemic redox status in survivors and non-survivors of critical illness

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