{"id":23195,"date":"2023-01-06T04:19:00","date_gmt":"2023-01-05T20:19:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23195"},"modified":"2023-01-06T05:44:04","modified_gmt":"2023-01-05T21:44:04","slug":"bmj%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%9c%af%e4%b8%ad%e6%b0%a7%e7%96%97%e4%b8%8e%e6%9c%af%e5%90%8e%e5%99%a8%e5%ae%98%e5%8a%9f%e8%83%bd%e6%8d%9f%e4%bc%a4","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23195","title":{"rendered":"[BMJ\u53d1\u8868\u8bba\u6587]\uff1a\u672f\u4e2d\u6c27\u7597\u4e0e\u672f\u540e\u5668\u5b98\u529f\u80fd\u635f\u4f24"},"content":{"rendered":"\n

Research<\/strong><\/p>\n\n\n\n

Oxygen administration during surgery and postoperative organ injury: observational cohort study<\/h1>\n\n\n\n

David R McIlroy, Matthew S Shotwell, Marcos G Lopez,\u00a0et al<\/h3>\n\n\n\n

BMJ<\/em>\u00a02022;\u00a0379\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj-2022-070941<\/a>\u00a0(Published 30 November 2022)Cite this as:\u00a0BMJ<\/em>\u00a02022;379:e070941<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Objective<\/strong> To examine whether supraphysiological oxygen administration during surgery is associated with lower or higher postoperative kidney, heart, and lung injury.<\/p>\n\n\n\n

Design<\/strong> Observational cohort study.<\/p>\n\n\n\n

Setting<\/strong> 42 medical centers across the United States participating in the Multicenter Perioperative Outcomes Group data registry.<\/p>\n\n\n\n

Participants<\/strong> Adult patients undergoing surgical procedures \u2265120 minutes\u2019 duration with general anesthesia and endotracheal intubation who were admitted to hospital after surgery between January 2016 and November 2018.<\/p>\n\n\n\n

Intervention<\/strong> Supraphysiological oxygen administration, defined as the area under the curve of the fraction of inspired oxygen above air (21%) during minutes when the hemoglobin oxygen saturation was greater than 92%.<\/p>\n\n\n\n

Main outcomes<\/strong> Primary endpoints were acute kidney injury defined using Kidney Disease Improving Global Outcomes criteria, myocardial injury defined as serum troponin >0.04 ng\/mL within 72 hours of surgery, and lung injury defined using international classification of diseases hospital discharge diagnosis codes.<\/p>\n\n\n\n

Results<\/strong> The cohort comprised 350\u2009647 patients with median age 59 years (interquartile range 46-69 years), 180\u2009546 women (51.5%), and median duration of surgery 205 minutes (interquartile range 158-279 minutes). Acute kidney injury was diagnosed in 19\u2009207 of 297\u2009554 patients (6.5%), myocardial injury in 8972 of 320\u2009527 (2.8%), and lung injury in 13\u2009789 of 312\u2009161 (4.4%). The median fraction of inspired oxygen was 54.0% (interquartile range 47.5%-60.0%), and the area under the curve of supraphysiological inspired oxygen was 7951% min (5870-11\u2009107% min), equivalent to an 80% fraction of inspired oxygen throughout a 135 minute procedure, for example. After accounting for baseline covariates and other potential confounding variables, increased oxygen exposure was associated with a higher risk of acute kidney injury, myocardial injury, and lung injury. Patients at the 75th centile for the area under the curve of the fraction of inspired oxygen had 26% greater odds of acute kidney injury (95% confidence interval 22% to 30%), 12% greater odds of myocardial injury (7% to 17%), and 14% greater odds of lung injury (12% to 16%) compared with patients at the 25th centile. Sensitivity analyses evaluating alternative definitions of the exposure, restricting the cohort, and conducting an instrumental variable analysis confirmed these observations.<\/p>\n\n\n\n

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Conclusions<\/strong> Increased supraphysiological oxygen administration during surgery was associated with a higher incidence of kidney, myocardial, and lung injury. Residual confounding of these associations cannot be excluded.<\/p>\n\n\n\n

Trial registration<\/strong> Open Science Framework osf.io\/cfd2m<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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