Hyperoxia during cardiopulmonary bypass does not decrease cardiovascular complications following cardiac surgery: the CARDIOX randomized clinical trial

Abou-Arab, Osama; Huette, Pierre; Martineau, Lucie; Beauvalot, Clémence; Beyls, Christophe; E, Josse; Touati, Gilles; Bouchot, Olivier; Bouhemad, Bélaïd; Diouf, Momar; Lorne, Emmanuel; Guinot, Pierre-Grégoire

doi:10.1007/s00134-019-05761-4

Cited by 31 publications

(22 citation statements)

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“…In fact, a series of recent larger studies has demonstrated that lower oxygen targets could be applied safely during CPB without detrimental cardiac and renal outcomes. 16,17,36 Our findings are in congruence with a large retrospective study of 1,018 patients having cardiac surgery with CPB that failed to demonstrate a relationship between arterial hyperoxia and neurocognitive function 6 weeks after surgery. 18 Our study did not find any significant differences in adverse outcomes with the use of a lower oxygenation target, although interpretation of these results in support of the safety of a lower oxygenation target must be made with caution.…”

Section: Intraoperative Oxygen and Cognition After Surgerysupporting

confidence: 85%

“…In interpreting these results, it is entirely plausible that the arterial oxygen content is a minor variable in the response to ischemia-reperfusion injury, dwarfed by that from the systemic inflammatory response to CPB. Other studies both in cardiac surgery 16,17,36 and allied specialties have not demonstrated statistically significant results regarding the detrimental effects of hyperoxia, albeit via varied outcome measurements. 12,[37][38][39] It must be borne in mind that this was a study of moderate compared with severe hyperoxia.…”

Section: Intraoperative Oxygen and Cognition After Surgerymentioning

confidence: 93%

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Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery

et al. 2020

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Background Despite evidence suggesting detrimental effects of perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac surgery. Hyperoxygenation may increase oxidative damage and neuronal injury leading to potential differences in postoperative neurocognition. Therefore, this study tested the primary hypothesis that intraoperative normoxia, as compared to hyperoxia, reduces postoperative cognitive dysfunction in older patients having cardiac surgery. Methods A randomized double-blind trial was conducted in patients aged 65 yr or older having coronary artery bypass graft surgery with cardiopulmonary bypass. A total of 100 patients were randomized to one of two intraoperative oxygen delivery strategies. Normoxic patients (n = 50) received a minimum fraction of inspired oxygen of 0.35 to maintain a Pao2 above 70 mmHg before and after cardiopulmonary bypass and between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients (n = 50) received a fraction of inspired oxygen of 1.0 throughout surgery, irrespective of Pao2 levels. The primary outcome was neurocognitive function measured on postoperative day 2 using the Telephonic Montreal Cognitive Assessment. Secondary outcomes included neurocognitive function at 1, 3, and 6 months, as well as postoperative delirium, mortality, and durations of mechanical ventilation, intensive care unit stay, and hospital stay. Results The median age was 71 yr (interquartile range, 68 to 75), and the median baseline neurocognitive score was 17 (16 to 19). The median intraoperative Pao2 was 309 (285 to 352) mmHg in the hyperoxia group and 153 (133 to 168) mmHg in the normoxia group (P < 0.001). The median Telephonic Montreal Cognitive Assessment score on postoperative day 2 was 18 (16 to 20) in the hyperoxia group and 18 (14 to 20) in the normoxia group (P = 0.42). Neurocognitive function at 1, 3, and 6 months, as well as secondary outcomes, were not statistically different between groups. Conclusions In this randomized controlled trial, intraoperative normoxia did not reduce postoperative cognitive dysfunction when compared to intraoperative hyperoxia in older patients having cardiac surgery. Although the optimal intraoperative oxygenation strategy remains uncertain, the results indicate that intraoperative hyperoxia does not worsen postoperative cognition after cardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Intraoperative Oxygen and Cognition After Surgerysupporting

confidence: 85%

Section: Intraoperative Oxygen and Cognition After Surgerymentioning

confidence: 93%

Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery

et al. 2020

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“…Cardiopulmponary bypass was standardised and comprise a heart-lung machine (Stockert Sorin S5, Heart Lung, Milan, Italy) with a target blood flow of 2.4 l/minutes per m 2 . [ 16 , 17 ] The mean arterial blood pressure (MAP) was maintained at more than 65 mm Hg by increasing the pump flow rate or, if required, by administering a bolus of phenylephrine (100 μg) or norepinephrine (5 μg). The pump primes for the CPB circuit contained 1500 ml of crystalloids (Plasma-Lyte; Baxter, Lessines, Belgium) and 5000 UI of heparin.…”

Section: Methodsmentioning

confidence: 99%

Anaesthesia and ICU sedation with sevoflurane do not reduce myocardial injury in patients undergoing cardiac surgery

et al. 2020

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Background: To evaluate the effect of anaesthesia and ICU sedation with sevoflurane to protect the myocardium against ischemia-reperfusion injury associated to cardiac surgery assessed by troponin release. Methods: We performed a prospective, open-label, randomized study in cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group and a control group. The main outcome was the perioperative kinetic of cardiac troponin I (cTnI). The secondary outcomes included composite endpoint, GDF-15 (macrophage inhibitory cytokine-1) value, arterial lactate levels, and the length of stay (LOS) in the ICU. Results: Of 82 included patients, 81 were analyzed on an intention-to-treat basis (intervention group: n = 42; control group: n = 39). On inclusion, the intervention and control groups did not differ significantly in terms of demographic and surgical data. The postoperative kinetics of cTnI did not differ significantly between groups: the mean difference was 0.44 ± 1.09 μg/ml, P = .69. Incidence of composite endpoint and GDF-15 values were higher in the sevoflurane group than in propofol group. The intervention and control groups did not differ significantly in terms of ICU stay and hospital stay. Conclusion: The use of an anaesthesia and ICU sedation with sevoflurane was not associated with a lower incidence of myocardial injury assessed by cTnI. Sevoflurane administration was associated with higher prevalence of acute renal failure and higher GDF-15 values.

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“…Premedication (alprazolam) was administered at the patient's request on the day before and the day of surgery. Cardiopulmonary bypass management was standardized for all patients as previously described [16][17][18] . Patient monitoring during anesthesia comprised continuous measurement of invasive blood, heart rate, oxygen saturation (SpO 2 ), central venous pressure, hypnosis (bispectral analysis (BIS XP monitor, Medtronic, France)), bladder temperature, diuresis, neuromuscular monitoring (NMT), and inspired/expired fraction of carbon dioxide and oxygen.…”

mentioning

confidence: 99%

“…Patient monitoring during anesthesia comprised continuous measurement of invasive blood, heart rate, oxygen saturation (SpO 2 ), central venous pressure, hypnosis (bispectral analysis (BIS XP monitor, Medtronic, France)), bladder temperature, diuresis, neuromuscular monitoring (NMT), and inspired/expired fraction of carbon dioxide and oxygen. Anesthesia induction was performed with propofol (Schnider model) and sufentanyl (Gepts model) administered by effect-site target-controlled infusion (Base Primea; Fresenius-Kabi, Germany) 16 . Propofol initial effect-site target concentration (Ce) was set at 4 μg/ml.…”

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confidence: 99%

Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

Berthoud

Nguyen

Appriou

et al. 2020

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Pupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

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Hyperoxia during cardiopulmonary bypass does not decrease cardiovascular complications following cardiac surgery: the CARDIOX randomized clinical trial

Cited by 31 publications

References 28 publications

Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery

Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery

Anaesthesia and ICU sedation with sevoflurane do not reduce myocardial injury in patients undergoing cardiac surgery

Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

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