Bronwen B Grocott1, Hessam H Kashani1, Hendrick Maakamedi2, Vikas Dutta1, Brett Hiebert3, Martin Rakar3, Hilary P Grocott4. 1. Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada. 2. Department of Anaesthesiology, University of Pretoria, South Africa. 3. Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada. 4. Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada. Electronic address: hgrocott@sbgh.mb.ca.
Abstract
OBJECTIVE: To characterize the institutional oxygen management practices during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery, including any potential changes during an 8-year study period. DESIGN: A retrospective cohort study. SETTING: A tertiary care cardiac surgical program. PARTICIPANTS: Patients who underwent cardiac surgery involving CPB, with or without hypothermic circulatory arrest (HCA), between January 1, 2010, and December 31, 2017. MEASUREMENTS AND MAIN RESULTS: In addition to baseline patient characteristics, the authors recorded the partial pressures of arterial oxygen (Pao2), fraction of inspired oxygen, and mixed venous oxygen saturation during CPB of 696 randomly selected patients during an 8-year study period. The overall mean Pao2 was 255 ± 48 mmHg, without any significant change during the 8-year study period (p = 0.30). The mean Pao2 of HCA patients was significantly higher than in patients without HCA (327 ± 93 mmHg v 252 ± 45 mmHg, respectively; p < 0.001). CONCLUSIONS: The current approach to oxygen management during CPB at the authors' institution is within the range of hyperoxemic levels, and these practices have not changed over time. The impact of these practices on patients' outcomes is not fully understood, and additional studies are needed to establish firm evidence to guide optimal oxygen management practice during CPB.
OBJECTIVE: To characterize the institutional oxygen management practices during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery, including any potential changes during an 8-year study period. DESIGN: A retrospective cohort study. SETTING: A tertiary care cardiac surgical program. PARTICIPANTS: Patients who underwent cardiac surgery involving CPB, with or without hypothermic circulatory arrest (HCA), between January 1, 2010, and December 31, 2017. MEASUREMENTS AND MAIN RESULTS: In addition to baseline patient characteristics, the authors recorded the partial pressures of arterial oxygen (Pao2), fraction of inspired oxygen, and mixed venous oxygen saturation during CPB of 696 randomly selected patients during an 8-year study period. The overall mean Pao2 was 255 ± 48 mmHg, without any significant change during the 8-year study period (p = 0.30). The mean Pao2 of HCA patients was significantly higher than in patients without HCA (327 ± 93 mmHg v 252 ± 45 mmHg, respectively; p < 0.001). CONCLUSIONS: The current approach to oxygen management during CPB at the authors' institution is within the range of hyperoxemic levels, and these practices have not changed over time. The impact of these practices on patients' outcomes is not fully understood, and additional studies are needed to establish firm evidence to guide optimal oxygen management practice during CPB.
Authors: Anthony Calhoun; Ameeka Pannu; Ariel L Mueller; Omar Elmadhoun; Juan D Valencia; Megan L Krajewski; Brian P O'Gara; Anastasia Katsiampoura; Sean T O'Connor; Louis Chu; Erika Monteith; Puja Shankar; Kyle Spear; Shahzad Shaefi Journal: J Cardiothorac Vasc Anesth Date: 2022-01-19 Impact factor: 2.894