Evaluation of hyperoxia-induced hypercapnia in obese patients after cardiac surgery: a randomized crossover comparison o
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Evaluation of hyperoxia-induced hypercapnia in obese patients after cardiac surgery: a randomized crossover comparison of conservative and liberal oxygen administration E´valuation de l’hypercapnie induite par hyperoxie chez des patients obe`ses apre`s une chirurgie cardiaque: comparaison avec devis croise´ d’une administration d’oxyge`ne conservatrice vs libe´rale . Carolanne Ruel, MD . Mathieu Simon, MD . Marie-He´le`ne Denault, MD Pierre-Alexandre Bouchard, RT . Serge Simard, MSc . Franc¸ois Lellouche, PhD Received: 10 April 2019 / Revised: 26 July 2019 / Accepted: 4 August 2019 Ó Canadian Anesthesiologists’ Society 2019
Abstract Purpose Recent studies on patients with stable obesityhypoventilation syndrome have raised concerns about hyperoxia-induced hypercapnia in this population. This study aimed to evaluate whether a higher oxygen saturation target would increase arterial partial pressure of carbon dioxide (PaCO2) in obese patients after coronary artery bypass grafting surgery (CABG). Methods Obese patients having CABG were recruited. With a randomized crossover design, we compared two oxygenation strategies for 30 min each, immediately after extubation: a peripheral oxygen saturation (SpO2) target of C 95% achieved with manual oxygen titration (liberal) and a SpO2 target of 90% achieved with FreeO2, an automated oxygen titration device (conservative). The main outcome was end-of-period arterial PaCO2. Results Thirty patients were included. Mean (standard deviation [SD]) body mass index (BMI) was 34 (3) kgm-2 and mean (SD) baseline partial pressure of carbon dioxide
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-019-01500-x) contains supplementary material, which is available to authorized users. M.-H. Denault, MD (&) C. Ruel, MD M. Simon, MD P.-A. Bouchard, RT S. Simard, MSc F. Lellouche, PhD Institut universitaire de cardiologie et de pneumologie de Que´bec - Universite´ Laval Research Center, 2725 Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada e-mail: [email protected]
(PCO2) was 40.7 (3.1) mmHg. Mean (SD) end-of-period PaCO2 was 42.0 (5.4) mmHg in the conservative period, compared with 42.6 (4.6) mmHg in the liberal period [mean difference - 0.6 (95% confidence interval - 2.2 to 0.9) mmHg; P = 0.4]. Adjusted analysis for age, BMI, narcotics, and preoperative PaCO2 did not substantively change the results. Fourteen patients were retainers, showing an elevation in mean (SD) PaCO2 in the liberal period of 3.3 (4.1) mmHg. Eleven patients had the opposite response, with a mean (SD) end-of-period PaCO2 decrease of 1.8 (2.2) mmHg in the liberal period. Five patients had a neutral response. Conclusion This study did not show a clinically important increase in PaCO2 associated with higher SpO2 values in this specific population of obese patients after CABG. Partial pressure of carbon dioxide increased with liberal oxygen administration in almost half of the patients, but no predictive factor was iden
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