Conservative versus conventional oxygen therapy for cardiac surgical patients

A before-and-after study

Glenn M. Eastwood, Matthew J. Chan, Leah Peck, Helen Young, Johan Mårtensson, Neil J. Glassford, Hidetoshi Kagaya, Satoshi Suzuki, Sean Galvin, George Matalanis, Rinaldo Bellomo

Research output: Contribution to journalArticle

Abstract

Avoiding hypoxaemia is considered crucial in cardiac surgery patients admitted to the intensive care unit (ICU). However, avoiding hyperoxaemia may also be important. A conservative approach to oxygen therapy may reduce exposure to hyperoxaemia without increasing the risk of hypoxaemia. Using a before-and-after design, we evaluated the introduction of conservative oxygen therapy (target SpO2 88%–92% using the lowest FiO2) for cardiac surgical patients admitted to the ICU. We studied 9041 arterial blood gas (ABG) datasets: 4298 ABGs from 245 ‘conventional’ and 4743 ABGs from 298 ‘conservative’ oxygen therapy patients. During mechanical ventilation (MV) and while in the ICU, compared to the conventional group, conservative group patients had significantly lower FiO2 exposure and PaO2 values (P < 0.001 for each). Accordingly, using the mean PaO2 during MV, more conservative group patients were classified as normoxaemic (226 versus 62 patients, P < 0.01), fewer as hyperoxaemic (66 versus 178 patients, P < 0.01) and no patient in either group as hypoxaemic or severely hypoxaemic. Moreover, more ABG samples were hyperoxaemic or severely hyperoxaemic during conventional treatment (P < 0.001). Finally, there was no difference in ICU or hospital length of stay, ICU or hospital mortality or 30-day mortality between the groups. Our findings support the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU after cardiac surgery.

Original languageEnglish
Pages (from-to)175-182
Number of pages8
JournalAnaesthesia and Intensive Care
Volume47
Issue number2
DOIs
Publication statusPublished - Mar 1 2019
Externally publishedYes

Fingerprint

Oxygen
Intensive Care Units
Therapeutics
Artificial Respiration
Thoracic Surgery
Length of Stay
Gases
Hospital Mortality
Safety
Mortality
Conservative Treatment

Keywords

  • Cardiac surgery
  • intensive care
  • mechanical ventilation
  • oxygen therapy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

Cite this

Eastwood, G. M., Chan, M. J., Peck, L., Young, H., Mårtensson, J., Glassford, N. J., ... Bellomo, R. (2019). Conservative versus conventional oxygen therapy for cardiac surgical patients: A before-and-after study. Anaesthesia and Intensive Care, 47(2), 175-182. https://doi.org/10.1177/0310057X19838753

Conservative versus conventional oxygen therapy for cardiac surgical patients : A before-and-after study. / Eastwood, Glenn M.; Chan, Matthew J.; Peck, Leah; Young, Helen; Mårtensson, Johan; Glassford, Neil J.; Kagaya, Hidetoshi; Suzuki, Satoshi; Galvin, Sean; Matalanis, George; Bellomo, Rinaldo.

In: Anaesthesia and Intensive Care, Vol. 47, No. 2, 01.03.2019, p. 175-182.

Research output: Contribution to journalArticle

Eastwood, GM, Chan, MJ, Peck, L, Young, H, Mårtensson, J, Glassford, NJ, Kagaya, H, Suzuki, S, Galvin, S, Matalanis, G & Bellomo, R 2019, 'Conservative versus conventional oxygen therapy for cardiac surgical patients: A before-and-after study', Anaesthesia and Intensive Care, vol. 47, no. 2, pp. 175-182. https://doi.org/10.1177/0310057X19838753
Eastwood, Glenn M. ; Chan, Matthew J. ; Peck, Leah ; Young, Helen ; Mårtensson, Johan ; Glassford, Neil J. ; Kagaya, Hidetoshi ; Suzuki, Satoshi ; Galvin, Sean ; Matalanis, George ; Bellomo, Rinaldo. / Conservative versus conventional oxygen therapy for cardiac surgical patients : A before-and-after study. In: Anaesthesia and Intensive Care. 2019 ; Vol. 47, No. 2. pp. 175-182.
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