Comparable Postoperative Pulmonary Atelectasis in Patients Given 30% or 80% Oxygen during and 2 Hours after Colon Resection

Author:

Akça Ozan1,Podolsky Andrea2,Eisenhuber Edith3,Panzer Oliver1,Hetz Hubert4,Lampl Karl4,Lackner Franz X.5,Wittmann Karin6,Grabenwoeger Florian7,Kurz Andrea8,Schultz Anette-Marie4,Negishi Chiharu9,Sessler Daniel I.10

Affiliation:

1. Research Fellow, Outcomes Research™ Group, Department of Anesthesiology and General Intensive Care, University of Vienna.

2. Attending Physician, Department of Internal Medicine–Pulmonology, University of Vienna.

3. Resident, Department of Radiology, University of Vienna.

4. Resident, Department of Anesthesiology and General Intensive Care, University of Vienna.

5. Professor and Vice Chair, Department of Anesthesiology and General Intensive Care, University of Vienna.

6. Resident, Department of Internal Medicine–Pulmonology, University of Vienna.

7. Professor, Department of Radiology, University of Vienna.

8. Professor and Associate Director, Outcomes Research™ Group, Department of Anesthesiology and General Intensive Care, University of Vienna; Assistant Professor, Department of Anesthesiology, Washington University, St. Louis.

9. Research Fellow, Outcomes Research™ Group, Department of Anesthesia and Perioperative Care, University of California–San Francisco.

10. Professor, Department of Anesthesia and Perioperative Care, University of California–San Francisco; Professor, Ludwig Boltzmann Institute for Clinical Anesthesia and Intensive Care; Director, Outcomes Research™ Group; Professor and Vice Chair, Department of Anesthesiology and General Intensive Care, University of Vienna.

Abstract

Background High concentrations of inspired oxygen are associated with pulmonary atelectasis but also provide recognized advantages. Consequently, the appropriate inspired oxygen concentration for general surgical use remains controversial. The authors tested the hypothesis that atelectasis and pulmonary dysfunction on the first postoperative day are comparable in patients given 30% or 80% perioperative oxygen. Methods Thirty patients aged 18-65 yr were anesthetized with isoflurane and randomly assigned to 30% or 80% oxygen during and for 2 h after colon resection. Chest radiographs and pulmonary function tests (forced vital capacity and forced expiratory volume) were obtained preoperatively and on the first postoperative day. Arterial blood gas measurements were obtained intraoperatively, after 2 h of recovery, and on the first postoperative day. Computed tomography scans of the chest were also obtained on the first postoperative day. Results Postoperative pulmonary mechanical function was significantly reduced compared with preoperative values, but there was no difference between the groups at either time. Arterial gas partial pressures and the alveolar-arterial oxygen difference were also comparable in the two groups. All preoperative chest radiographs were normal. Postoperative radiographs showed atelectasis in 36% of the patients in the 30%-oxygen group and in 44% of those in the 80%-oxygen group. Relatively small amounts of pulmonary atelectasis (expressed as a percentage of total lung volume) were observed on the computed tomography scans, and the percentages (mean +/- SD) did not differ significantly in the patients given 30% oxygen (2.5% +/- 3.2%) or 80% oxygen (3.0% +/- 1.8%). These data provided a 99% chance of detecting a 2% difference in atelectasis volume at an alpha level of 0.05. Conclusions Lung volumes, the incidence and severity of atelectasis, and alveolar gas exchange were comparable in patients given 30% and 80% perioperative oxygen. The authors conclude that administration of 80% oxygen in the perioperative period does not worsen lung function. Therefore, patients who may benefit from generous oxygen partial pressures should not be denied supplemental perioperative oxygen for fear of causing atelectasis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference39 articles.

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