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

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...

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Autores principales: Smit, Bob, Smulders, Yvo M., de Waard, Monique C., Boer, Christa, Vonk, Alexander B. A., Veerhoek, Dennis, Kamminga, Suzanne, de Grooth, Harm-Jan S., García-Vallejo, Juan J., Musters, Rene J. P., Girbes, Armand R. J., Oudemans - van Straaten, Heleen M., Spoelstra - de Man, Angelique M. E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788916/
https://www.ncbi.nlm.nih.gov/pubmed/26968380
http://dx.doi.org/10.1186/s13054-016-1240-6
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author Smit, Bob
Smulders, Yvo M.
de Waard, Monique C.
Boer, Christa
Vonk, Alexander B. A.
Veerhoek, Dennis
Kamminga, Suzanne
de Grooth, Harm-Jan S.
García-Vallejo, Juan J.
Musters, Rene J. P.
Girbes, Armand R. J.
Oudemans - van Straaten, Heleen M.
Spoelstra - de Man, Angelique M. E.
author_facet Smit, Bob
Smulders, Yvo M.
de Waard, Monique C.
Boer, Christa
Vonk, Alexander B. A.
Veerhoek, Dennis
Kamminga, Suzanne
de Grooth, Harm-Jan S.
García-Vallejo, Juan J.
Musters, Rene J. P.
Girbes, Armand R. J.
Oudemans - van Straaten, Heleen M.
Spoelstra - de Man, Angelique M. E.
author_sort Smit, Bob
collection PubMed
description 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 (P(a)O(2)) 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 P(a)O(2) 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 P(a)O(2) was 107 mmHg (86–141) vs. 90 (84–98) (P = 0.03), respectively. Area under the curve of CK-MB was median 23.5 μg/L/h (IQR 18.4–28.1) vs. 21.5 (15.8–26.6) (P = 0.35) and 0.30 μg/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. TRIAL REGISTRATION: Netherlands Trial Registry NTR4375, registered on 30 January 2014 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-016-1240-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-47889162016-03-13 Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial Smit, Bob Smulders, Yvo M. de Waard, Monique C. Boer, Christa Vonk, Alexander B. A. Veerhoek, Dennis Kamminga, Suzanne de Grooth, Harm-Jan S. García-Vallejo, Juan J. Musters, Rene J. P. Girbes, Armand R. J. Oudemans - van Straaten, Heleen M. Spoelstra - de Man, Angelique M. E. Crit Care Research 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 (P(a)O(2)) 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 P(a)O(2) 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 P(a)O(2) was 107 mmHg (86–141) vs. 90 (84–98) (P = 0.03), respectively. Area under the curve of CK-MB was median 23.5 μg/L/h (IQR 18.4–28.1) vs. 21.5 (15.8–26.6) (P = 0.35) and 0.30 μg/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. TRIAL REGISTRATION: Netherlands Trial Registry NTR4375, registered on 30 January 2014 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-016-1240-6) contains supplementary material, which is available to authorized users. BioMed Central 2016-03-10 2016 /pmc/articles/PMC4788916/ /pubmed/26968380 http://dx.doi.org/10.1186/s13054-016-1240-6 Text en © Smit et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Smit, Bob
Smulders, Yvo M.
de Waard, Monique C.
Boer, Christa
Vonk, Alexander B. A.
Veerhoek, Dennis
Kamminga, Suzanne
de Grooth, Harm-Jan S.
García-Vallejo, Juan J.
Musters, Rene J. P.
Girbes, Armand R. J.
Oudemans - van Straaten, Heleen M.
Spoelstra - de Man, Angelique M. E.
Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial
title Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial
title_full Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial
title_fullStr Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial
title_full_unstemmed Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial
title_short Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial
title_sort moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788916/
https://www.ncbi.nlm.nih.gov/pubmed/26968380
http://dx.doi.org/10.1186/s13054-016-1240-6
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