Oxygen reserve index guided fraction of inspired oxygen titration to reduce hyperoxemia during laparoscopic gastrectomy: A randomized controlled trial

The usefulness of the oxygen reserve index (ORi) in reducing hyperoxemia remains unclear. We designed this study to investigate whether fraction of inspired oxygen (FiO(2)) adjustment under a combination of ORi and peripheral oxygen saturation (SpO(2)) guidance can reduce intraoperative hyperoxemia compared to SpO(2) alone. METHODS: In this prospective, double-blind, randomized controlled study, we allocated patients scheduled for laparoscopic gastrectomy to the SpO(2) group (FiO(2) adjusted to target SpO(2) ≥ 98%) or the ORi-SpO(2) group (FiO(2) adjusted to target 0 < 0 ORi < .3 and SpO(2) ≥ 98%). The ORi, SpO(2), FiO(2), arterial partial pressure of oxygen (PaO(2)), and incidence of severe hyperoxemia (PaO(2 ≥) 200 mm Hg) were recorded before and 1, 2, and 3 hours after surgical incision. Data from 32 and 30 subjects in the SpO(2) and ORi-SpO(2) groups, respectively, were analyzed. RESULTS: PaO(2) was higher in the SpO(2) group (250.31 ± 57.39 mm Hg) than in the ORi-SpO(2) group (170.07 ± 49.39 mm Hg) 1 hour after incision (P < .001). PaO(2) was consistently higher in the SpO(2) group than in the ORi-SpO(2) group, over time (P = .045). The incidence of severe hyperoxemia was higher in the SpO(2) group (84.4%) than in the ORi-SpO(2) group (16.7%, P < .001) 1 hour after incision. Higher FiO(2) was administered to the SpO(2) group [52.5 (50–60)] than the ORi-SpO(2) group [40 (35–50), P < .001] 1 hour after incision. SpO(2) was not different between the 2 groups. CONCLUSION: The combination of ORi and SpO(2) guided FiO(2) adjustment reduced hyperoxemia compared to SpO(2) alone during laparoscopic gastrectomy.