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Title: Conservative versus conventional oxygen therapy for cardiac surgical patients: A before-and-after study.
Austin Authors: 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 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Australia
Department of Surgery, Wellington Regional Hospital, New Zealand
Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 2019
Date: 2019-05-21
Publication information: Anaesthesia and Intensive Care 2019; 47(2): 175-182
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.
DOI: 10.1177/0310057X19838753
ORCID: 0000-0001-8739-7896
Journal: Anaesthesia and Intensive Care
PubMed URL: 31112037
ISSN: 0310-057X
Type: Journal Article
Subjects: Cardiac surgery
intensive care
mechanical ventilation
oxygen therapy
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