Supraphysiologic Oxygen During Surgery Linked to Organ Damage

Odds of acute kidney injury, myocardial injury, lung injury may be increased for those exposed to supraphysiological oxygen.

HealthDay News — Supraphysiological oxygen administration during surgery is associated with increased odds of kidney, myocardial, and lung injury, according to a study published online Nov. 30 in The BMJ.

David R. McIlroy, M.D., from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues conducted an observational cohort study in 42 medical centers across the United States to examine whether supraphysiological oxygen administration during surgery is associated with lower or higher postoperative kidney, heart, and lung injury. The cohort included 350,647 patients (median age, 59 years).

The researchers found that 6.5, 2.8, and 4.4 percent of the patients were diagnosed with acute kidney injury, myocardial injury, and lung injury, respectively. The median fraction of inspired oxygen was 54.0 percent. Increased oxygen exposure was associated with a higher risk for acute kidney injury, myocardial injury, and lung injury after accounting for baseline covariates and other potential confounding variables. The odds of acute kidney injury, myocardial injury, and lung injury were increased 26, 12, and 14 percent, respectively, for patients at the 75th versus the 25th centile for the area under the curve of the fraction of inspired oxygen. These observations were confirmed in sensitivity analyses.

“Increased intraoperative oxygen exposure was associated with adverse renal, cardiac, and pulmonary outcomes in a large, diverse cohort of surgical patients,” the authors write. “A large clinical trial to detect small but clinically significant effects on organ injury and patient centered outcomes is needed to guide oxygen administration during surgery.”

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