Intraoperative Fraction of Inspired Oxygen and Lung Injury in Coronary Artery Bypass Grafting: Study Protocol for a Randomised Controlled Trial.

Autor: Song K; Department of Anesthesiology and Perioperative Medicine University of Louisville, Louisville, KY, USA;Department of Anesthesiology, Peking Union Medical College, Beijing, PR China., Wang S; Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China., Han J; Department of Anesthesiology, Tianjin Chest Hospital, Tianjin, China., Jiang L; Department of Anesthesiology, Peking University People's Hospital, Beijing, China., Xu J; Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China., Akca O; Department of Anesthesiology and Perioperative Medicine University of Louisville, Louisville, KY, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, USA., Adkins K; Department of Cardiovascular - Thoracic Surgery, University of Louisville, Louisville, KY, USA., Koenig HM; Department of Anesthesiology and Perioperative Medicine University of Louisville, Louisville, KY, USA., Slaughter MS; Department of Cardiovascular - Thoracic Surgery, University of Louisville, Louisville, KY, USA., Clifford SP; Department of Anesthesiology and Perioperative Medicine University of Louisville, Louisville, KY, USA., Huang Y; Department of Anesthesiology, Peking Union Medical College, Beijing, PR China., Huang J; Department of Anesthesiology and Perioperative Medicine University of Louisville, Louisville, KY, USA;Department of Cardiovascular - Thoracic Surgery, University of Louisville, Louisville, KY, USA;Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, USA;The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, Kentucky, USA;Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
Jazyk: angličtina
Zdroj: Turkish journal of anaesthesiology and reanimation [Turk J Anaesthesiol Reanim] 2023 Apr; Vol. 51 (2), pp. 112-120.
DOI: 10.5152/TJAR.2023.22974
Abstrakt: Objective: Postoperative pulmonary complications are a series of disorders that can contribute to respiratory distress and prolonged mechanical ventilation postoperatively. We hypothesise that a liberal oxygenation strategy during cardiac surgery leads to a higher incidence of postoperative pulmonary complications than a restrictive oxygenation strategy.
Methods: This study is a prospective, observer-blinded, centrally randomised and controlled, international multicentre clinical trial.
Results: After obtaining a written informed consent, 200 adult patients undergoing coronary artery bypass grafting will be enrolled and randomised to receive either restrictive or liberal oxygenation perioperatively. The liberal oxygenation group will receive 1.0 fraction of inspired oxygen throughout the intraoperative period, including during cardiopulmonary bypass. The restrictive oxygenation group will receive the lowest fraction of inspired oxygen required to maintain arterial partial pressure of oxygen between 100 and 150 mmHg during cardiopulmonary bypass and a pulse oximetry reading of 95% or greater intraoperatively, but no less than 0.3 and not higher than 0.80 (other than induction and when the oxygenation goals cannot be reached). When patients are transferred to the intensive care unit, all patients will receive an initial fraction of inspired oxygen of 0.5, and then fraction of inspired oxygen will be titrated to maintain a pulse oximetry reading of 95% or greater until extubation. The lowest postoperative arterial partial pressure of oxygen/fraction of inspired oxygen within 48 hours of intensive care unit admission will be the primary outcome. Postoperative pulmonary complications, length of mechanical ventilation, intensive care unit stay, hospital stay, and 7-day mortality after cardiac surgery will be analysed as secondary outcomes.
Conclusion: This is one of the first randomised controlled observer-blinded trials that prospectively evaluates the influence of higher inspired oxygen fractions on early postoperative respiratory and oxygenation outcomes in cardiac surgery patients using cardiopulmonary bypass.
Databáze: MEDLINE
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