Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial

被引：50

作者：

Smit, Bob ^{[1
]}

Smulders, Yvo M. ^{[2
]}

de Waard, Monique C. ^{[1
]}

Boer, Christa ^{[3
]}

Vonk, Alexander B. A. ^{[4
]}

Veerhoek, Dennis ^{[4
]}

Kamminga, Suzanne ^{[3
]}

de Grooth, Harm-Jan S. ^{[1
]}

Garcia-Vallejo, Juan J. ^{[5
]}

Musters, Rene J. P. ^{[6
]}

Girbes, Armand R. J. ^{[1
]}

Oudemans-van Straaten, Heleen M. ^{[1
]}

Spoelstra-de Man, Angelique M. E. ^{[1
]}

机构：

[1] Vrije Univ Amsterdam, Med Ctr, Dept Intens Care, Amsterdam, Netherlands

[2] Vrije Univ Amsterdam, Med Ctr, Dept Internal Med, Amsterdam, Netherlands

[3] Vrije Univ Amsterdam, Med Ctr, Dept Anaesthesiol, Amsterdam, Netherlands

[4] Vrije Univ Amsterdam, Med Ctr, Dept Cardiothorac Surg, Amsterdam, Netherlands

[5] Vrije Univ Amsterdam, Med Ctr, Dept Mol Cell Biol & Immunol, Amsterdam, Netherlands

[6] Vrije Univ Amsterdam, Med Ctr, Dept Physiol, Amsterdam, Netherlands

来源：

CRITICAL CARE | 2016年 / 20卷

关键词：

Hyperoxia; Oxygen; Intensive care unit; Cardiac surgery; CABG; MECHANICALLY VENTILATED PATIENTS; RESPIRATORY-DISTRESS-SYNDROME; CARDIAC-ARREST; CARDIOPULMONARY BYPASS; VITAMIN-C; SUPPLEMENTAL OXYGEN; NITRIC-OXIDE; TENSION; VASOCONSTRICTION; DEXAMETHASONE;

D O I：

10.1186/s13054-016-1240-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: The safety of perioperative hyperoxia is currently unclear. Previous studies in patients undergoing coronary artery bypass surgery suggest reduced myocardial damage when avoiding extreme perioperative hyperoxia (> 400 mmHg). In this study we investigated whether an oxygenation strategy from moderate hyperoxia to a near-physiological oxygen tension reduces myocardial damage and improves haemodynamics, organ dysfunction and oxidative stress. Methods: This was a single-blind, single-centre, open-label, randomised controlled trial in patients undergoing elective coronary artery bypass surgery. Fifty patients were randomised to a partial pressure of oxygen in arterial blood (PaO2) target of 200-220 mmHg during cardiopulmonary bypass and 130-150 mmHg during intensive care unit (ICU) admission (control group) versus lower targets of 130-150 mmHg during cardiopulmonary bypass and 80-100 mmHg at the ICU (conservative group). Primary outcome was myocardial injury (CK-MB and Troponin-T) at ICU admission and 2, 6 and 12 hours thereafter. Results: Weighted PaO2 during cardiopulmonary bypass was 220 mmHg (interquartile range (IQR) 211-233) vs. 157 (151-162) in the control and conservative group, respectively (P < 0.0001). During ICU admission, weighted PaO2 was 107 mmHg (86-141) vs. 90 (84-98) (P = 0.03), respectively. Area under the curve of CK-MB was median 23.5 mu g/L/h (IQR 18.4-28.1) vs. 21.5 (15.8-26.6) (P = 0.35) and 0.30 mu g/L/h (0.25-0.44) vs. 0.39 (0.24-0.43) (P = 0.81) for Troponin-T. Cardiac index, systemic vascular resistance index, creatinine, lactate and F2-isoprostane levels were not different between groups. Conclusions: Compared to moderate hyperoxia, a near-physiological oxygen strategy does not reduce myocardial damage in patients undergoing coronary artery bypass surgery. Conservative oxygen administration was not associated with increased lactate levels or hypoxic events.

引用

页数：10

共 42 条

[1] Human cardiovascular dose-response to supplemental oxygen [J].