Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: A randomized controlled trial.

Publisher: Elsevier Country of Publication: United States NLM ID: 8812166 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4529 (Electronic) Linking ISSN: 09528180 NLM ISO Abbreviation: J Clin Anesth Subsets: MEDLINE

Publication: <2008->: New York : Elsevier
Original Publication: [Stoneham, MA] : Butterworths, [c1988-

Abdomen*/surgery ; Postoperative Complications*/epidemiology ; Postoperative Complications*/etiology ; Postoperative Complications*/prevention & control ; Positive-Pressure Respiration*/methods ; Oxygen* ; Anesthesia, General*/methods ; Anesthesia, General*/adverse effects; Humans ; Male ; Female ; Middle Aged ; Prospective Studies ; Aged ; Lung Diseases/etiology ; Lung Diseases/prevention & control ; Lung Diseases/epidemiology ; Adult ; Incidence ; China/epidemiology ; Tidal Volume

Study Objective: The aim of the present study was to determine the effect of 30 % fraction of inspired oxygen (FIO 2 ) compared with 80 % FIO 2 in the context of driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery.
Design: A single-center, prospective, randomized controlled trial.
Setting: Tertiary university hospital in China.
Patients: 514 adult patients, ASA I-III and scheduled for major open abdominal surgery under general anesthesia.
Interventions: Patients were randomly assigned to receive either 30 % or 80 % FIO 2 during the intraoperative period. All patients received driving pressure-guided ventilation strategy, including low tidal volume and individualized PEEP set at lowest driving pressure.
Measurements: The primary outcome was the incidence of a composite of pulmonary complications within the 7 days postoperatively. The severity of pulmonary complications, extrapulmonary complications, and other secondary outcomes were also assessed.
Main Results: Of 1553 patients assessed for eligibility, 514 patients were randomly assigned and analyzed with intention-to-treat principle. Patients receiving 30 % FIO 2 had a significantly lower incidence of postoperative pulmonary complications (PPCs) compared to those receiving 80 % FIO 2 (46.3 %vs. 64.6 %; RR, 0.72; 95 % CI, 0.61-0.84; P < 0.001). The severity score of PPCs was significantly reduced in the 30 % FIO 2 group compared with that in the 80 % FIO 2 group within the 7 postoperative days (P < 0.001). Dynamic compliance was significantly greater in 30 % FIO 2 group at the end of surgery (56 [48-66] vs. 53 [46-62], P = 0.027). More patients in the 80 % FIO 2 group developed oxygen desaturation (SpO 2  < 94 %) on air intake during PACU stay (18.5 %vs. 30.4 %; RR, 0.61; 95 % CI, 0.44-0.84; P = 0.002; 30 % FIO 2 group vs.80 % FIO 2 group).
Conclusions: In patients undergoing open abdominal surgery, using a 30 % FIO 2 , compared with 80 % FIO 2 , in context of driving pressure-guided ventilation strategy, intraoperatively reduced the incidence and severity of pulmonary complications within the first 7 postoperative days.
Competing Interests: Declaration of competing interest The authors declare that they have no competing interests in the study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
(Copyright © 2024 Elsevier Inc. All rights reserved.)

Keywords: Driving pressure; Inspiratory oxygen fraction; Open abdominal surgery.; Postoperative pulmonary complications

S88TT14065 (Oxygen)

Date Created: 20241107 Date Completed: 20241124 Latest Revision: 20241126

20241202

10.1016/j.jclinane.2024.111676

39509739