Cardiothoracic & vascular anesthesia
Impaired oxygenation after lung resection: Incidence and perioperative risk factors
Authors' conclusion
Impaired postoperative oxygenation is common after lung resection and is associated with potentially modifiable pre- and intraoperative respiratory factors.
Study context
- Population
- ASA I–IV patients undergoing lung resection at two large US academic hospitals
- Participants
- 3,081 patients
- Outcome
- Impaired oxygenation: SpO2 < 92% or imputed PaO2/FiO2 < 300 mmHg (at least twice within 24 h), or intensive oxygen therapy (mechanical ventilation, > 50% oxygen or high-flow oxygen)
- Follow-up
- Within seven postoperative days
Methodological detailsregistry-based, two centres
- Registry-based
- Two centres
Main finding
As reported in the abstract
Impaired oxygenation within 7 postoperative days · 7 postoperative days
- Oxygenation impaired within 7 postoperative days
- 70.8%
- PaO2/FiO2 < 200 mmHg or intensive oxygen therapy
- 26.6%
- Intraoperative median driving pressure, per additional cmH2O (multivariable): OR
- 1.07 (95%CI 1.04 to 1.10)
- Median intraoperative FiO2, per 0.1 (multivariable): OR
- 1.23 (95%CI 1.14 to 1.31)
- PEEP, per 1 cm H2O (multivariable): OR
- 1.12 (95%CI 1.04 to 1.21)
- History of COPD (multivariable): OR
- 2.55 (95%CI 1.95 to 3.35)
- Intraoperative albuterol administration (multivariable): OR
- 2.07 (95%CI 1.17 to 3.67)
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Risk factors for impaired oxygenation (multivariable analysis)Intraoperative median driving pressure, per additional cmH2O · 7% higher risk | 1.07 (1.04–1.10) | |
| Risk factors for impaired oxygenation (multivariable analysis)Higher median intraoperative FiO2, per 0.1 | 1.23 (1.14–1.31) | |
| Risk factors for impaired oxygenation (multivariable analysis)PEEP, per 1 cm H2O | 1.12 (1.04–1.21) | |
| 0.512Odds ratio (log scale) |
Risk factors for impaired oxygenation (multivariable analysis)
| OR (95% CI) | ||
|---|---|---|
| History of COPD | 2.55 (1.95–3.35) | |
| Intraoperative albuterol administration | 2.07 (1.17–3.67) | |
| 0.20.5125Odds ratio (log scale) |
- Risk factors for impaired oxygenation (multivariable analysis): 79 pre- and intraoperative variables selected by a causal inference framework
Original publication
Impaired oxygenation after lung resection: Incidence and perioperative risk factors. J Clin Anesth. Published 7 May 2024. doi:10.
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