Comparison of low and high inspiratory oxygen fraction added to lung-protective ventilation on postoperative pulmonary complications after abdominal surgery: A randomized controlled trial

Li, Xuefei; Jiang, Dan; Jiang, Yu-Lian; Yu, Hong; Zhang, Meng‐Qiu; Jiang, Jia-Li; He, Leilei; Yu, Hai

doi:10.1016/j.jclinane.2020.110009

Cited by 29 publications

(28 citation statements)

References 48 publications

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“…Cardiac dysfunction was de ned as postoperative minimal ejection fraction (EF) < 50%. Postoperative respiratory infection was identi ed as follows: if a patient received antibiotics for suspected respiratory infection and met at least one of the following criteria: new or changed sputum, new or changed lung opacities, fever, leukocyte count > 12,000 × 10 9 L − 1 [23] .…”

Section: Discussionmentioning

confidence: 99%

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

Peng

Wei

Zeng

et al. 2021

Preprint

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Backgroundː Impairment of cerebral autoregulation (CA) has been observed in patients undergoing cardiopulmonary bypass (CPB), but little is known about its occurrence and associations with outcomes. The objective of this study was to analyze the occurrence of impaired CA, based on cerebral oximetry index (COx), in patients undergoing total aortic arch replacement with CPB and moderate hypothermic circulatory arrest (MHCA). We also evaluated the association between impaired CA and patient outcomes.Methodsː Sixty-four patients who underwent total aortic arch replacement with stented elephant trunk implantation under CPB and MHCA at our hospital were retrospectively analyzed. Patients were defined as having new-onset impaired CA if post-CPB COx > 0.3, calculated based on a moving linear correlation coefficient between regional cerebral oxygen saturation (rScO2) and mean blood pressure (MAP). Postoperative complication and in-hospital mortality were compared between patients with normal and impaired CA.Resultsː Of the 64 patients, 19(29.7%) developed new-onset impaired CA after CPB with MHCA. Compared with normal CA patients, those with impaired CA showed a significantly longer duration of rScO2 <55%, and significantly higher rates of in-hospital mortality and postoperative complications (acute kidney injury, delirium, mechanical ventilation > 24h, and respiratory infection). Conclusionsː In our cohort, 29.7% of patients who underwent total aortic arch replacement developed new-onset impaired CA after CPB with MHCA. Impaired CA might be associated with significantly increased rates of postoperative complications and in-hospital mortality. Clinical trial registration: ChiCTR1800014545 with registered date 20/01/2018.

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Section: Discussionmentioning

confidence: 99%

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

Peng

Wei

Zeng

et al. 2021

Preprint

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“…The ARISCAT score was evaluated according to age, preoperative SpO 2 , respiratory infection in the last month, anaemia, duration of surgery and emergency procedure; a score <26 was regarded as low risk, 26–44 as moderate risk and ≥44 as high risk (online supplemental table S2). 24…”

Section: Methodsmentioning

confidence: 99%

Positive end-expiratory pressure and risk of postoperative pulmonary complications in patients living at high altitudes and undergoing surgery at low altitudes: a single-centre, retrospective observational study in China

et al. 2022

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ObjectivesTo examine whether a high positive end-expiratory pressure (PEEP ≥5 cmH2O) has a protective effect on the risk of postoperative pulmonary complications (PPCs) in a cohort of patients living at high altitudes and undergoing general anaesthesia.DesignRetrospective, observational study.SettingA tertiary hospital in China.ParticipantsAdult Tibetan patients living at high altitudes (≥3000 m) and who went to the low-altitude plain to undergo non-cardiothoracic surgery under general anaesthesia, from January 2018 to April 2020.MeasurementsThis study included 1905 patients who were divided according to the application of an intraoperative PEEP: low PEEP (<5 cmH2O, including 0 cmH2O) or high PEEP (≥5 cmH2O). The primary outcome was a composite of PPCs within the first 7 postoperative days. The secondary outcomes included reintubation and unplanned intensive care unit (ICU) admission within the first 7 postoperative days and total hospital stays (day).ResultsThe study included 1032 patients in the low PEEP group and 873 in the high PEEP group. There were no differences in the incidence of PPCs between the high and low PEEP groups (relative risk (RR) 0.913; 95% CI 0.716 to 1.165; p=0.465). After propensity score matching, 643 patients remained in each group, and the incidence of PPCs in the low PEEP group (18.0%) was higher than in the high PEEP group (13.7%; RR 0.720; 95% CI 0.533 to 0.974; p=0.033). There were no differences in the incidence of reintubation, unplanned ICU admission or hospital stays. The risk factors of PPCs derived from multiple regression showed that the application of >5 cmH2O PEEP during intraoperative mechanical ventilation was associated with a significantly lower risk of PPCs in patients from a high altitude (OR=0.725, 95% CI 0.530 to 0.992; p=0.044).ConclusionsThe application of PEEP ≥5 cmH2O during intraoperative mechanical ventilation in patients living at high altitudes and undergoing surgery at low altitudes may be associated with a lower risk of PPCs. Prospective longitudinal studies are needed to further investigate perioperative lung protection ventilation strategies for patients from high altitudes.Trial registration numberChinese Clinical Trial Registry (ChiCTR2100044260).

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“…Cardiac dysfunction was de ned as the minimal EF < 50% during postoperative hospitalization. Postoperative respiratory infection was identi ed as follows: if a patient received antibiotics for suspected respiratory infection and met at least one of the following criteria: new or changed sputum, new or changed lung opacities, fever, leukocyte count > 12,000 × 10 9 L − 1 [23].…”

Section: Data Collection and De Nitionmentioning

confidence: 99%

The incidence, risk factors and outcomes of impaired cerebral autoregulation in aortic arch surgery: a single-center, retrospective cohort study

Peng

Guo

Shi

et al. 2022

Preprint

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Backgroundː Impairment of cerebral autoregulation (CA) has been observed in patients undergoing cardiopulmonary bypass (CPB), but little is known about its risks and associations with outcomes. The objective of this study was to analyze the incidence and risks of impaired CA, based on cerebral oximetry index (COx), in patients undergoing total aortic arch replacement with CPB and moderate hypothermic circulatory arrest (MHCA). We also evaluated the association between impaired CA and patient outcomes.Methodsː One hundred fifteen four adult patients who underwent total aortic arch replacement with stented elephant trunk implantation under CPB and MHCA at our hospital were retrospectively analyzed. Patients were defined as having new-onset impaired CA if post-CPB COx > 0.3, calculated based on a moving linear correlation coefficient between regional cerebral oxygen saturation (rScO2) and mean blood pressure (MAP). Pre- and intraoperative factors were tested for independent association with impaired CA. Postoperative outcomes were compared between patients with normal and impaired CA.Resultsː In our 154 patients, 46(29.9%) developed new-onset impaired CA after CPB with MHCA. Multivariate analysis revealed a prolonged low rScO2 (rScO2 <55%) independently associated with onset of impaired CA, and receiver operating charactoristic curve showed a cutoff value at 40 min (sensitivity, 89.5%; specificity, 68.0%). Compared with normal CA patients, those with impaired CA showed a significantly higher rates of in-hospital mortality and postoperative complications.Conclusionː Prolonged low rScO2 (rScO2 <55%) during aortic arch surgery was closely related to onset of impaired CA. Impaired CA remained associated with the increased rates of postoperative complications and in-hospital mortality.Trial registration: ChiCTR1800014545 with registered date 20/01/2018.

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Comparison of low and high inspiratory oxygen fraction added to lung-protective ventilation on postoperative pulmonary complications after abdominal surgery: A randomized controlled trial

Cited by 29 publications

References 48 publications

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

Positive end-expiratory pressure and risk of postoperative pulmonary complications in patients living at high altitudes and undergoing surgery at low altitudes: a single-centre, retrospective observational study in China

The incidence, risk factors and outcomes of impaired cerebral autoregulation in aortic arch surgery: a single-center, retrospective cohort study

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