Current ventilator and oxygen management during general anesthesia

A multicenter, cross-sectional observational study

Okayama Research Investigation Organizing Network (ORION) investigators

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. Methods: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%). Results: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60). Conclusions: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.

Original languageEnglish
Pages (from-to)67-76
Number of pages10
JournalAnesthesiology
Volume129
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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Mechanical Ventilators
General Anesthesia
Observational Studies
Cross-Sectional Studies
Oxygen
One-Lung Ventilation
Oximetry
Positive-Pressure Respiration
Vital Signs
Ventilation
Japan
Emergencies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Current ventilator and oxygen management during general anesthesia : A multicenter, cross-sectional observational study. / Okayama Research Investigation Organizing Network (ORION) investigators.

In: Anesthesiology, Vol. 129, No. 1, 01.01.2018, p. 67-76.

Research output: Contribution to journalArticle

Okayama Research Investigation Organizing Network (ORION) investigators. / Current ventilator and oxygen management during general anesthesia : A multicenter, cross-sectional observational study. In: Anesthesiology. 2018 ; Vol. 129, No. 1. pp. 67-76.
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abstract = "Background: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. Methods: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98{\%}, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92{\%}). Results: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92{\%}), whereas it was less than or equal to 0.3 in very few patients (1{\%}). Most patients (83{\%}) were exposed to potentially preventable hyperoxemia, and 32{\%} had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95{\%} CI, 7.24 to 24.60). Conclusions: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.",
author = "{Okayama Research Investigation Organizing Network (ORION) investigators} and Satoshi Suzuki and Yuko Mihara and Yukiko Hikasa and Shuji Okahara and Takuma Ishihara and Ayumi Shintani and Hiroshi Morimatsu and Akiko Sato and Sachio Kusume and Hidekuni Hidaka and Hidehiko Yatsuzuka and Masahiro Okawa and Makoto Takatori and Shinsei Saeki and Takeshi Samuta and Hiroaki Tokioka and Toshiaki Kurasako and Masato Maeda and Mamoru Takeuchi and Akihito Hirasaki and Michio Kitaura and Hideki Kajiki and Osamu Kobayashi and Hiroshi Katayama and Hideki Nakatsuka and Satoshi Mizobuchi and Seiji Sugimoto and Masataka Yokoyama and Kazuhito Kusudo and Kensuke Shiraishi and Toshio Iwaki and Tatsuhiko Komatsu and Yasuo Hirai and Tetsufumi Sato and Masakazu Kimura and Takeshi Yasukawa and Motonobu Kimura and Masahiro Taniguchi and Yutaka Shimoda and Yoji Kobayashi and Mitsunori Tsukioki and Nobuki Manabe and Eiji Ando and Makoto Kosaka and Takashi Tsukiji and Chika Tokura and Yasuhiro Asao and Masatoshi Sugiyama and Kozo Seto",
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T2 - A multicenter, cross-sectional observational study

AU - Okayama Research Investigation Organizing Network (ORION) investigators

AU - Suzuki, Satoshi

AU - Mihara, Yuko

AU - Hikasa, Yukiko

AU - Okahara, Shuji

AU - Ishihara, Takuma

AU - Shintani, Ayumi

AU - Morimatsu, Hiroshi

AU - Sato, Akiko

AU - Kusume, Sachio

AU - Hidaka, Hidekuni

AU - Yatsuzuka, Hidehiko

AU - Okawa, Masahiro

AU - Takatori, Makoto

AU - Saeki, Shinsei

AU - Samuta, Takeshi

AU - Tokioka, Hiroaki

AU - Kurasako, Toshiaki

AU - Maeda, Masato

AU - Takeuchi, Mamoru

AU - Hirasaki, Akihito

AU - Kitaura, Michio

AU - Kajiki, Hideki

AU - Kobayashi, Osamu

AU - Katayama, Hiroshi

AU - Nakatsuka, Hideki

AU - Mizobuchi, Satoshi

AU - Sugimoto, Seiji

AU - Yokoyama, Masataka

AU - Kusudo, Kazuhito

AU - Shiraishi, Kensuke

AU - Iwaki, Toshio

AU - Komatsu, Tatsuhiko

AU - Hirai, Yasuo

AU - Sato, Tetsufumi

AU - Kimura, Masakazu

AU - Yasukawa, Takeshi

AU - Kimura, Motonobu

AU - Taniguchi, Masahiro

AU - Shimoda, Yutaka

AU - Kobayashi, Yoji

AU - Tsukioki, Mitsunori

AU - Manabe, Nobuki

AU - Ando, Eiji

AU - Kosaka, Makoto

AU - Tsukiji, Takashi

AU - Tokura, Chika

AU - Asao, Yasuhiro

AU - Sugiyama, Masatoshi

AU - Seto, Kozo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. Methods: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%). Results: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60). Conclusions: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.

AB - Background: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. Methods: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%). Results: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60). Conclusions: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.

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DO - 10.1097/ALN.0000000000002181

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