High intraoperative inspiratory oxygen fraction and risk of major respiratory complications.

Autor:	Staehr-Rye AK; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.; Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark., Meyhoff CS; Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Scheffenbichler FT; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA., Vidal Melo MF; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA., Gätke MR; Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark., Walsh JL; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA., Ladha KS; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA., Grabitz SD; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA., Nikolov MI; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA., Kurth T; Institute of Public Health, Charité Universitätzmedizin Berlin, Germany., Rasmussen LS; Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark., Eikermann M; Department of Anaesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.; Klinik für Anaesthesie und Intensivmedizin, Universitaetsklinikum Essen, Essen, Germany.
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2017 Jul 01; Vol. 119 (1), pp. 140-149.
DOI:	10.1093/bja/aex128
Abstrakt:	Background: High inspiratory oxygen fraction ( FIO2 ) may improve tissue oxygenation but also impair pulmonary function. We aimed to assess whether the use of high intraoperative FIO2 increases the risk of major respiratory complications. Methods: We studied patients undergoing non-cardiothoracic surgery involving mechanical ventilation in this hospital-based registry study. The cases were divided into five groups based on the median FIO2 between intubation and extubation. The primary outcome was a composite of major respiratory complications (re-intubation, respiratory failure, pulmonary oedema, and pneumonia) developed within 7 days after surgery. Secondary outcomes included 30-day mortality. Several predefined covariates were included in a multivariate logistic regression model. Results: The primary analysis included 73 922 cases, of whom 3035 (4.1%) developed a major respiratory complication within 7 days of surgery. For patients in the high- and low-oxygen groups, the median FIO2 was 0.79 [range 0.64-1.00] and 0.31 [0.16-0.34], respectively. Multivariate logistic regression analysis revealed that the median FIO2 was associated in a dose-dependent manner with increased risk of respiratory complications (adjusted odds ratio for high vs low FIO2 1.99, 95% confidence interval [1.72-2.31], P -value for trend <0.001). This finding was robust in a series of sensitivity analyses including adjustment for intraoperative oxygenation. High median FIO2 was also associated with 30-day mortality (odds ratio for high vs low FIO2 1.97, 95% confidence interval [1.30-2.99], P -value for trend <0.001). Conclusions: In this analysis of administrative data on file, high intraoperative FIO2 was associated in a dose-dependent manner with major respiratory complications and with 30-day mortality. The effect remained stable in a sensitivity analysis controlled for oxygenation. Clinical Trial Registration: NCT02399878. (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com)
Databáze:	MEDLINE
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