Individual FiO2 guided by SPO2 prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial

Xia Wei; Xia Kang; Lijun Zhang; Jinzhu Huang; Weiyu Feng; Pengyu Duan; Bing Zhang

doi:10.1016/j.jclinane.2024.111732

Individual FiO₂ guided by S_PO₂ prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial

J Clin Anesth. 2024 Dec 26:101:111732. doi: 10.1016/j.jclinane.2024.111732. Online ahead of print.

Authors

Xia Wei¹, Xia Kang², Lijun Zhang³, Jinzhu Huang³, Weiyu Feng³, Pengyu Duan³, Bing Zhang⁴

Affiliations

¹ Department of Anesthesiology, Harbin Medical University Cancer Hospital, China.
² Department of Anesthesiology, HongHui Hospital, Xi'an JiaoTong University, China.
³ Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, China.
⁴ Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, China; The Key Laboratory of Anesthesiology and Intensive Care Research of Heilongjiang Province, China. Electronic address: 600771@hrbmu.edu.cn.

PMID: 39729933
DOI: 10.1016/j.jclinane.2024.111732

Abstract

Study objective: To determine whether individualized fraction of inspired oxygen (iFiO₂) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO₂.

Design: This was a single-center, prospective, randomized study.

Setting: This study was conducted in a single tertiary care hospital in China.

Patients: A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.

Interventions: The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO₂ group) or individualized FiO₂ based on physiological SpO₂ (iFiO₂ group).

Measurements: The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO₂, oxygenation index, alveolar-arterial oxygen tension gradient (A-aDO₂), and pulmonary shunt fraction (Qs/Qt) were considered.

Main results: The LUS was significantly lowered in the iFiO₂ group (5 [4, 7]) compared with the fFiO₂ group (8 [4, 10]) (P = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO₂ group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO₂ group (P = 0.025). At the end of surgery, PaO₂, A-aDO₂, and Qs/Qt were significantly reduced in patients in the iFiO₂ group compared with those in the fFiO₂ group.

Conclusions: The use of iFiO₂ during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.

Clinical trial registration: ChiCTRT2100049615.

Keywords: Atelectasis; Hyperoxia; Individualized fraction of inspired oxygen; Pulse oxygen saturation; Titration.