High intraoperative inspiratory oxygen fraction and risk of major respiratory complications

High inspiratory oxygen fraction ( FIO2) may improve tissue oxygenation but also impair pulmonary function. We aimed to assess whether the use of high intraoperative FIO2 increases the risk of major respiratory complications. We studied patients undergoing non-cardiothoracic surgery involving mechan...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 2017-07, Vol.119 (1), p.140-149
Main Authors: Staehr-Rye, A.K., Meyhoff, C.S., Scheffenbichler, F.T., Vidal Melo, M.F., Gätke, M.R., Walsh, J.L., Ladha, K.S., Grabitz, S.D., Nikolov, M.I., Kurth, T., Rasmussen, L.S., Eikermann, M.
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Humans
Intraoperative Period
Logistic Models
Male
Middle Aged
oxygen
Oxygen - blood
Oxygen Inhalation Therapy - adverse effects
Oxygen Inhalation Therapy - methods
postoperative complications
Postoperative Complications - etiology
Respiration Disorders - etiology
respiratory insufficiency
Respiratory Insufficiency - etiology
respiratory therapy
Risk
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Summary:High inspiratory oxygen fraction ( FIO2) may improve tissue oxygenation but also impair pulmonary function. We aimed to assess whether the use of high intraoperative FIO2 increases the risk of major respiratory complications. We studied patients undergoing non-cardiothoracic surgery involving mechanical ventilation in this hospital-based registry study. The cases were divided into five groups based on the median FIO2 between intubation and extubation. The primary outcome was a composite of major respiratory complications (re-intubation, respiratory failure, pulmonary oedema, and pneumonia) developed within 7 days after surgery. Secondary outcomes included 30-day mortality. Several predefined covariates were included in a multivariate logistic regression model. The primary analysis included 73 922 cases, of whom 3035 (4.1%) developed a major respiratory complication within 7 days of surgery. For patients in the high- and low-oxygen groups, the median FIO2 was 0.79 [range 0.64–1.00] and 0.31 [0.16–0.34], respectively. Multivariate logistic regression analysis revealed that the median FIO2 was associated in a dose-dependent manner with increased risk of respiratory complications (adjusted odds ratio for high vs low FIO2 1.99, 95% confidence interval [1.72–2.31], P-value for trend
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/aex128