{"title":"一项随机对照试验：SPO2引导下的个体FiO2可预防结直肠手术中的高氧并减少术后肺不张。","authors":"Xia Wei , Xia Kang , Lijun Zhang , Jinzhu Huang , Weiyu Feng , Pengyu Duan , Bing Zhang","doi":"10.1016/j.jclinane.2024.111732","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><div>To determine whether individualized fraction of inspired oxygen (iFiO<sub>2</sub>) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO<sub>2</sub>.</div></div><div><h3>Design</h3><div>This was a single-center, prospective, randomized study.</div></div><div><h3>Setting</h3><div>This study was conducted in a single tertiary care hospital in China.</div></div><div><h3>Patients</h3><div>A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.</div></div><div><h3>Interventions</h3><div>The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO<sub>2</sub> group) or individualized FiO<sub>2</sub> based on physiological SpO<sub>2</sub> (iFiO<sub>2</sub> group).</div></div><div><h3>Measurements</h3><div>The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO<sub>2</sub>, oxygenation index, alveolar–arterial oxygen tension gradient (A-aDO<sub>2</sub>), and pulmonary shunt fraction (Qs/Qt) were considered.</div></div><div><h3>Main results</h3><div>The LUS was significantly lowered in the iFiO<sub>2</sub> group (5 [4, 7]) compared with the fFiO<sub>2</sub> group (8 [4, 10]) (<em>P</em> = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO<sub>2</sub> group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO<sub>2</sub> group (<em>P</em> = 0.025). At the end of surgery, PaO<sub>2</sub>, A-aDO<sub>2</sub>, and Qs/Qt were significantly reduced in patients in the iFiO<sub>2</sub> group compared with those in the fFiO<sub>2</sub> group.</div></div><div><h3>Conclusions</h3><div>The use of iFiO<sub>2</sub> during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.</div><div>Clinical trial registration: ChiCTRT2100049615.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111732"},"PeriodicalIF":5.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Individual FiO2 guided by SPO2 prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial\",\"authors\":\"Xia Wei , Xia Kang , Lijun Zhang , Jinzhu Huang , Weiyu Feng , Pengyu Duan , Bing Zhang\",\"doi\":\"10.1016/j.jclinane.2024.111732\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Study objective</h3><div>To determine whether individualized fraction of inspired oxygen (iFiO<sub>2</sub>) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO<sub>2</sub>.</div></div><div><h3>Design</h3><div>This was a single-center, prospective, randomized study.</div></div><div><h3>Setting</h3><div>This study was conducted in a single tertiary care hospital in China.</div></div><div><h3>Patients</h3><div>A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.</div></div><div><h3>Interventions</h3><div>The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO<sub>2</sub> group) or individualized FiO<sub>2</sub> based on physiological SpO<sub>2</sub> (iFiO<sub>2</sub> group).</div></div><div><h3>Measurements</h3><div>The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO<sub>2</sub>, oxygenation index, alveolar–arterial oxygen tension gradient (A-aDO<sub>2</sub>), and pulmonary shunt fraction (Qs/Qt) were considered.</div></div><div><h3>Main results</h3><div>The LUS was significantly lowered in the iFiO<sub>2</sub> group (5 [4, 7]) compared with the fFiO<sub>2</sub> group (8 [4, 10]) (<em>P</em> = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO<sub>2</sub> group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO<sub>2</sub> group (<em>P</em> = 0.025). At the end of surgery, PaO<sub>2</sub>, A-aDO<sub>2</sub>, and Qs/Qt were significantly reduced in patients in the iFiO<sub>2</sub> group compared with those in the fFiO<sub>2</sub> group.</div></div><div><h3>Conclusions</h3><div>The use of iFiO<sub>2</sub> during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.</div><div>Clinical trial registration: ChiCTRT2100049615.</div></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"101 \",\"pages\":\"Article 111732\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818024003623\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818024003623","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Individual FiO2 guided by SPO2 prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial
Study objective
To determine whether individualized fraction of inspired oxygen (iFiO2) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO2.
Design
This was a single-center, prospective, randomized study.
Setting
This study was conducted in a single tertiary care hospital in China.
Patients
A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.
Interventions
The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO2 group) or individualized FiO2 based on physiological SpO2 (iFiO2 group).
Measurements
The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO2, oxygenation index, alveolar–arterial oxygen tension gradient (A-aDO2), and pulmonary shunt fraction (Qs/Qt) were considered.
Main results
The LUS was significantly lowered in the iFiO2 group (5 [4, 7]) compared with the fFiO2 group (8 [4, 10]) (P = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO2 group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO2 group (P = 0.025). At the end of surgery, PaO2, A-aDO2, and Qs/Qt were significantly reduced in patients in the iFiO2 group compared with those in the fFiO2 group.
Conclusions
The use of iFiO2 during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.
期刊介绍：
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
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