Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

Jakutis, Gabrielius; Norkienė, Ieva; Ringaitienė, Donata; Jovaiša, Tomas Raimundas

doi:10.6001/actamedica.v24i3.3549

Cited by 8 publications

(5 citation statements)

References 18 publications

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“… 32 In a study by Sutton et al 33 conducted on cardiac surgery patients, an increase in both ICU and hospital stays was observed in hyperoxemic patients. Similar to our study, in a study by Jakutis et al, 16 while the duration of ICU stay was not affected by hyperoxemia, the length of hospital stay was prolonged. In our study, the length of stay in the ICU was not affected despite the prolongation of the MV period with the routine postoperative ICU stay of at least 36 hours in the cardiac surgery protocols applied in our clinic.…”

Section: Discussionsupporting

confidence: 92%

“… 15 It was observed that liberal oxygen therapy (PO 2 =190–300 mmHg) was associated with prolonged MV duration compared with conservative oxygen therapy (PO 2 =75–112 mmHg). 16 In a more recent study, Jakutis et al 16 showed that the duration of MV was longer in patients with severe hyperoxemia (PO 2 >300 mmHg) during CPB. Various studies have also indicated that hypoxemia affects the duration of MV in cardiac surgery.…”

Section: Discussionmentioning

confidence: 98%

“… 20 Although several studies have shown that high oxygen prevents SSI, larger studies have shown that there is no association between high oxygen levels and SSI. 16 , 21 - 23 In a study by Pryor et al 24 on general surgery patients, it was shown that the use of high perioperative FiO 2 did not reduce the overall incidence of SSI, but it could have harmful effects (bleeding and increased need for transfusion). In this study, no positive effect of hyperoxemia on SSI was observed.…”

Section: Discussionmentioning

confidence: 99%

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Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass

Ak¹,

Ozsahin²,

Yeşiltaş³

et al. 2022

JTHC

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass

Ak¹,

Ozsahin²,

Yeşiltaş³

et al. 2022

JTHC

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“…Oxygen, whilst vital, can also be toxic, with both oxidative stress and cellular hyperoxia identified as major contributors to multiple pathological states (Evans, 2016). Historically, under-oxygenation was (and still remains) the key concern in patients undergoing cardiac surgery, although recent studies are starting to highlight the pathological dangers of over-oxygenation during CPB, with an ongoing debate around the level of damage (Jakutis et al, 2017; Young 2012; Abou-Arab et al, 2020). Equally, being able to define what these terms (over- and under-oxygenation) mean is complex.…”

Section: Physiological Interpretation Of Findingsmentioning

confidence: 99%

Mathematical Modelling of Oxygenation Dynamics using High-Resolution Perfusion Data - Part 1: Statistical Framework

Sharabiani,

Mahani,

Issitt

et al. 2024

Preprint

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BackgroundDuring cardiopulmonary bypass (CPB), maintaining adequate oxygen consumption (VO2i) can only be achieved indirectly either by modifying oxygen delivery (DO2i) through its component parts or by modulating metabolic demand through altering body temperature. The body reacts to these actions by changing OER and consequently VO2i. Understanding the body’s adaptive OER dynamics can elucidate its oxygen consumption goals during CPB and help improve our ability to safely manage the patient’s journey.MethodsAn autoregressive, integrated time-series model was trained on granular perfusion data from 879 paediatric patients (age: newborn to 18 years old) undergoing 963 CPB operations, with the outcome variable being the minute-by-minute changes in the logit transformation of OER. Variables were cardiac index, haemoglobin concentration, oxygen saturation of arterial haemoglobin and temperature. An explicit ‘disequilibrium term group’ was also included, proportional to the difference between the logarithm of VO2i and logarithm of a ‘latent’ (i.e. unobserved) oxygen demand - or ‘target’ VO2(tVO2i) - term, with the logarithm of tVO2i assumed to be a linear function of body temperature (the Van’t Hoff model). The trained time-series models were studied using permutation-based variable importance, deterministic and stochastic simulations, and subgroup analysis by acute kidney injury (AKI) grade and by temperature.ResultsModel coefficients are consistent with an adaptive OER response to keep VO2i in line with tVO2i, according to body temperature. This adaptation consists of a primary rapid response for 5-10 minutes, and a secondary slow response that is estimated to last up to several hours. The model reproduces the hyperbolic shape of DO2i-VO2i curves - first published in 1982 - as an artefact of insufficient wait times between equilibrium-state transitions. Asymptotically, however, the model converges to a piecewise linear relationship between DO2i and VO2i, with supply-independence of oxygen consumption occurring above a threshold DO2i. Subgroup analysis by temperature suggests that the dependence of tVO2i on temperature (expressed as Q10) may be significantly stronger at low temperatures (< 28C) than at high temperatures (> 28C).ConclusionsThis study proposes a physiologically plausible model of OER changes during CPB that is consistent with past experimental data. While during CPB, under-oxygenation is the dominant risk in the long term, slow adaptation of OER during CPB creates short-term opportunities for over-oxygenation following significant changes in variables such as cardiac index. The model provides well-defined values for tVO2i at a given temperature, paving the way for further research into the effects of over- and under-oxygenation during CPB on postoperative outcomes such as AKI, and hence improvements in goal-directed perfusion protocols.Clinical PerspectiveWhat Is New?This study is the first to present a data-driven, analytical framework for predicting OER changes in response to clinical interventions during CPB.Changes in the components of oxygen delivery cause an adaptive OER response to keep oxygen consumption in line with oxygen demand, according to body temperature.The dependence of oxygen demand on temperature decreases as temperature increases towards normothermia, inconsistent with the accepted Van’t Hoff equation.Children developing AKI exhibit a dampened response to changes in haemoglobin during CPB, with this dampening of response intensifying with AKI severity.What Are the Clinical Implications?This proposed, dynamic model of OER provides a novel framework for goal-directed perfusion by identifying periods of over- and under-oxygenation.The observed, dampened response to haemoglobin changes in patients that develop AKI can be the foundation of an intraoperative tool for early diagnosis of at-risk patients.

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“…However, recent reports have described a potential association of hyperoxia with poor outcomes in select critical care populations (6)(7)(8)(9)(10)(11)(12), and the balance of benefits and risks of hyperoxia in patients undergoing CPB remains unknown (1,13). Oxidative stress from the generation of reactive oxygen species, hyperoxiarelated cardiovascular dysregulation, and inflammation and thrombosis from activation of neutrophils and platelets favor limiting the utilization of hyperoxia (1,(13)(14)(15)(16)(17). Additionally, high partial pressures of oxygen may be associated with an increase in systemic and coronary vascular resistance (1,(17)(18)(19) which impairs cardiac diastolic function (1,20).…”

mentioning

confidence: 99%

Hyperoxia During Cardiopulmonary Bypass Is Associated With Mortality in Infants Undergoing Cardiac Surgery*

Beshish

Jahadi

Mello

et al. 2021

Pediatric Critical Care Medicine

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Patients undergoing cardiac surgery using cardiopulmonary bypass have variable degrees of blood oxygen tension during surgery. Hyperoxia has been associated with adverse outcomes in critical illness. Data are not available regarding the association of hyperoxia and outcomes in infants undergoing cardiopulmonary bypass. We hypothesize that among infants undergoing cardiac surgery, hyperoxia during cardiopulmonary bypass is associated with greater odds of morbidity and mortality.DESIGN: Retrospective study. SETTING: Single center at an academic tertiary children's hospital.

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Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

Cited by 8 publications

References 18 publications

Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass

Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass

Mathematical Modelling of Oxygenation Dynamics using High-Resolution Perfusion Data - Part 1: Statistical Framework

Hyperoxia During Cardiopulmonary Bypass Is Associated With Mortality in Infants Undergoing Cardiac Surgery*

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