Alex Choi, Hao Deng, Mitchell Fuller, Jamie L Sparling, Min Zhu, Brooks Udelsman, Gyorgy Frendl, Marcos F Vidal Melo, Alexander Nagrebetsky
{"title":"肺切除术中术中FiO2和术后氧合受损风险：倾向评分加权分析。","authors":"Alex Choi, Hao Deng, Mitchell Fuller, Jamie L Sparling, Min Zhu, Brooks Udelsman, Gyorgy Frendl, Marcos F Vidal Melo, Alexander Nagrebetsky","doi":"10.1016/j.jclinane.2024.111739","DOIUrl":null,"url":null,"abstract":"<p><strong>Study objective: </strong>To assess whether, in a lung resection cohort with a low probability of confounding by indication, higher FiO<sub>2</sub> is associated with an increased risk of impaired postoperative oxygenation - a clinical manifestation of lung injury/dysfunction.</p><p><strong>Design: </strong>Pre-specified registry-based retrospective cohort study.</p><p><strong>Setting: </strong>Two large academic hospitals in the United States.</p><p><strong>Patients: </strong>2936 lung resection patients with an overall good intraoperative oxygenation (median intraoperative SpO<sub>2</sub> ≥ 95 %).</p><p><strong>Measurements: </strong>We compared patients with a higher (≥0.8) and lower (<0.8) median intraoperative FiO<sub>2</sub> after propensity score-weighting for 75 perioperative variables based on a causal inference framework. The primary outcome of impaired oxygenation was defined as at least one of the following within seven postoperative days: (1) SpO<sub>2</sub> < 92 %; (2) imputed PaO<sub>2</sub>/FiO<sub>2</sub> < 300 mmHg [(1) or (2) at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50 % oxygen or high-flow oxygen).</p><p><strong>Main results: </strong>Among the 2936 included patients, 2171 (73.8 %) received median intraoperative FiO<sub>2</sub> ≥ 0.8. Impaired postoperative oxygenation occurred in 1627 (74.9 %) and 422 (55.2 %) patients in the higher and lower FiO<sub>2</sub> groups, respectively. In a propensity score-weighted analysis, higher intraoperative FiO<sub>2</sub> was associated with an 84 % increase in the likelihood of impaired postoperative oxygenation (OR 1.84; 95 % CI 1.60 to 2.12; P < 0.001).</p><p><strong>Conclusions: </strong>Despite plausible harm from hyperoxia, high intraoperative FiO<sub>2</sub> is extremely common during lung resection. Nearly three-quarters of lung resection patients with acceptable oxygenation received median intraoperative FiO<sub>2</sub> ≥ 0.8. Such higher FiO<sub>2</sub> was associated with an increased risk of impaired postoperative oxygenation - a clinically relevant manifestation of lung injury or dysfunction. This observation supports the administration of a lower (< 0.8) intraoperative FiO<sub>2</sub> and its further assessment in clinical trials.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111739"},"PeriodicalIF":5.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative FiO<sub>2</sub> and risk of impaired postoperative oxygenation in lung resection: A propensity score-weighted analysis.\",\"authors\":\"Alex Choi, Hao Deng, Mitchell Fuller, Jamie L Sparling, Min Zhu, Brooks Udelsman, Gyorgy Frendl, Marcos F Vidal Melo, Alexander Nagrebetsky\",\"doi\":\"10.1016/j.jclinane.2024.111739\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study objective: </strong>To assess whether, in a lung resection cohort with a low probability of confounding by indication, higher FiO<sub>2</sub> is associated with an increased risk of impaired postoperative oxygenation - a clinical manifestation of lung injury/dysfunction.</p><p><strong>Design: </strong>Pre-specified registry-based retrospective cohort study.</p><p><strong>Setting: </strong>Two large academic hospitals in the United States.</p><p><strong>Patients: </strong>2936 lung resection patients with an overall good intraoperative oxygenation (median intraoperative SpO<sub>2</sub> ≥ 95 %).</p><p><strong>Measurements: </strong>We compared patients with a higher (≥0.8) and lower (<0.8) median intraoperative FiO<sub>2</sub> after propensity score-weighting for 75 perioperative variables based on a causal inference framework. The primary outcome of impaired oxygenation was defined as at least one of the following within seven postoperative days: (1) SpO<sub>2</sub> < 92 %; (2) imputed PaO<sub>2</sub>/FiO<sub>2</sub> < 300 mmHg [(1) or (2) at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50 % oxygen or high-flow oxygen).</p><p><strong>Main results: </strong>Among the 2936 included patients, 2171 (73.8 %) received median intraoperative FiO<sub>2</sub> ≥ 0.8. Impaired postoperative oxygenation occurred in 1627 (74.9 %) and 422 (55.2 %) patients in the higher and lower FiO<sub>2</sub> groups, respectively. In a propensity score-weighted analysis, higher intraoperative FiO<sub>2</sub> was associated with an 84 % increase in the likelihood of impaired postoperative oxygenation (OR 1.84; 95 % CI 1.60 to 2.12; P < 0.001).</p><p><strong>Conclusions: </strong>Despite plausible harm from hyperoxia, high intraoperative FiO<sub>2</sub> is extremely common during lung resection. Nearly three-quarters of lung resection patients with acceptable oxygenation received median intraoperative FiO<sub>2</sub> ≥ 0.8. Such higher FiO<sub>2</sub> was associated with an increased risk of impaired postoperative oxygenation - a clinically relevant manifestation of lung injury or dysfunction. This observation supports the administration of a lower (< 0.8) intraoperative FiO<sub>2</sub> and its further assessment in clinical trials.</p>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"101 \",\"pages\":\"111739\"},\"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://doi.org/10.1016/j.jclinane.2024.111739\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/3 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jclinane.2024.111739","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/3 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
研究目的：评估在适应症混淆概率较低的肺切除术队列中，较高的FiO2是否与术后氧合受损风险增加相关——这是肺损伤/功能障碍的临床表现。设计：预先指定的基于登记的回顾性队列研究。环境：美国两家大型学术医院。患者：2936例肺切除术患者术中氧合总体良好（术中SpO2中位数≥95%）。测量：基于因果推理框架，我们比较了75个围手术期变量的倾向评分加权后较高（≥0.8）和较低(2)的患者。氧合受损的主要结局定义为术后7天内至少有以下一项：(1)SpO2 /FiO2 50%氧或高流量氧)。主要结果：2936例患者中，2171例（73.8%）患者术中FiO2中位数≥0.8。高、低FiO2组术后氧合受损患者分别为1627例（74.9%）和422例（55.2%）。在倾向评分加权分析中，术中较高的FiO2与术后氧合受损可能性增加84%相关(OR 1.84；95% CI 1.60 - 2.12；结论：尽管高氧可能造成危害，但术中高FiO2在肺切除术中极为常见。近四分之三氧合可接受的肺切除术患者术中FiO2中位数≥0.8。如此高的FiO2与术后氧合受损的风险增加相关，这是肺损伤或功能障碍的临床相关表现。这一观察结果支持术中FiO2较低（< 0.8）的使用及其在临床试验中的进一步评估。
Intraoperative FiO2 and risk of impaired postoperative oxygenation in lung resection: A propensity score-weighted analysis.
Study objective: To assess whether, in a lung resection cohort with a low probability of confounding by indication, higher FiO2 is associated with an increased risk of impaired postoperative oxygenation - a clinical manifestation of lung injury/dysfunction.
Setting: Two large academic hospitals in the United States.
Patients: 2936 lung resection patients with an overall good intraoperative oxygenation (median intraoperative SpO2 ≥ 95 %).
Measurements: We compared patients with a higher (≥0.8) and lower (<0.8) median intraoperative FiO2 after propensity score-weighting for 75 perioperative variables based on a causal inference framework. The primary outcome of impaired oxygenation was defined as at least one of the following within seven postoperative days: (1) SpO2 < 92 %; (2) imputed PaO2/FiO2 < 300 mmHg [(1) or (2) at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50 % oxygen or high-flow oxygen).
Main results: Among the 2936 included patients, 2171 (73.8 %) received median intraoperative FiO2 ≥ 0.8. Impaired postoperative oxygenation occurred in 1627 (74.9 %) and 422 (55.2 %) patients in the higher and lower FiO2 groups, respectively. In a propensity score-weighted analysis, higher intraoperative FiO2 was associated with an 84 % increase in the likelihood of impaired postoperative oxygenation (OR 1.84; 95 % CI 1.60 to 2.12; P < 0.001).
Conclusions: Despite plausible harm from hyperoxia, high intraoperative FiO2 is extremely common during lung resection. Nearly three-quarters of lung resection patients with acceptable oxygenation received median intraoperative FiO2 ≥ 0.8. Such higher FiO2 was associated with an increased risk of impaired postoperative oxygenation - a clinically relevant manifestation of lung injury or dysfunction. This observation supports the administration of a lower (< 0.8) intraoperative FiO2 and its further assessment in clinical trials.
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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