Hyperoxia and Antioxidants for Myocardial Injury in Noncardiac Surgery: A 2 × 2 Factorial, Blinded, Randomized Clinical Trial.

Autor:	Holse C; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Aasvang EK; Department of Anaesthesia, Center for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Vester-Andersen M; Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anesthesiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark., Rasmussen LS; Centre of Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Wetterslev J; Copenhagen Trial Unit, Center for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark., Christensen R; Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark., Jorgensen LN; Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Pedersen SS; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Loft FC; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Troensegaard H; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Mørkenborg ML; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Stisen ZR; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark., Rünitz K; Department of Anaesthesia, Center for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark., Eiberg JP; Department of Vascular Surgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark., Hansted AK; Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anesthesiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark., Meyhoff CS; Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Jazyk:	angličtina
Zdroj:	Anesthesiology [Anesthesiology] 2022 Mar 01; Vol. 136 (3), pp. 408-419.
DOI:	10.1097/ALN.0000000000004117
Abstrakt:	Background: Hyperoxia and oxidative stress may be associated with increased risk of myocardial injury. The authors hypothesized that a perioperative inspiratory oxygen fraction of 0.80 versus 0.30 would increase the degree of myocardial injury within the first 3 days of surgery, and that an antioxidant intervention would reduce degree of myocardial injury versus placebo. Methods: A 2 × 2 factorial, randomized, blinded, multicenter trial enrolled patients older than 45 yr who had cardiovascular risk factors undergoing major noncardiac surgery. Factorial randomization allocated patients to one of two oxygen interventions from intubation and at 2 h after surgery, as well as antioxidant intervention or matching placebo. Antioxidants were 3 g IV vitamin C and 100 mg/kg N-acetylcysteine. The primary outcome was the degree of myocardial injury assessed by the area under the curve for high-sensitive troponin within the first 3 postoperative days. Results: The authors randomized 600 participants from April 2018 to January 2020 and analyzed 576 patients for the primary outcome. Baseline and intraoperative characteristics did not differ between groups. The primary outcome was 35 ng · day/l (19 to 58) in the 80% oxygen group; 35 ng · day/l (17 to 56) in the 30% oxygen group; 35 ng · day/l (19 to 54) in the antioxidants group; and 33 ng · day/l (18 to 57) in the placebo group. The median difference between oxygen groups was 1.5 ng · day/l (95% CI, -2.5 to 5.3; P = 0.202) and -0.5 ng · day/l (95% CI, -4.5 to 3.0; P = 0.228) between antioxidant groups. Mortality at 30 days occurred in 9 of 576 patients (1.6%; odds ratio, 2.01 [95% CI, 0.50 to 8.1]; P = 0.329 for the 80% vs. 30% oxygen groups; and odds ratio, 0.79 [95% CI, 0.214 to 2.99]; P = 0.732 for the antioxidants vs. placebo groups). Conclusions: Perioperative interventions with high inspiratory oxygen fraction and antioxidants did not change the degree of myocardial injury within the first 3 days of surgery. This implies safety with 80% oxygen and no cardiovascular benefits of vitamin C and N-acetylcysteine in major noncardiac surgery. (Copyright © 2022, the American Society of Anesthesiologists. All Rights Reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu