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Whats New in the
Patient Safety World
January 2023
Oxygen During
Surgery
Appropriate use of oxygen therapy is important. Several of
our prior columns on use of oxygen in non-hypoxemic
patients have shown the potential for untoward side effects.
A new study (McIlroy 2022)
analyzed data on over 250,000 adult patients undergoing surgical procedures
≥120 minutes duration with general anesthesia and endotracheal
intubation at 42 medical centers across the United States. These medical centers
were participating in the Multicenter Perioperative Outcomes Group data
registry. Excess use of oxygen was defined as oxygen concentrations greater
than 21% for any period during which oxygen saturation was greater than 92%.
After accounting for baseline covariates and other potential
confounding variables, increased oxygen exposure was associated with a higher
risk of acute kidney injury, myocardial injury, and lung injury.
Patients at the 75th centile for the area under the curve of
the fraction of inspired oxygen had 26% greater odds of acute kidney injury,
12% greater odds of myocardial injury, and 14% greater odds of lung injury
compared with patients at the 25th centile.
Secondary outcomes included 30-day mortality, hospital length
of stay, and stroke. Increased supraphysiological oxygen administration was
associated with stroke (p<0.001) and 30-day mortality (p=0.03), independent
of all factors included as covariates. Patients at the 75th centile compared to
those at the 25th centile of excess oxygen exposure had 9% greater odds of
stroke and 6% greater odds of 30-day mortality.
Increased supraphysiological oxygen administration was
associated with decreased hospital length of stay (p<0.001). Patients at the
75th centile had a 0.20 day shorter length
of stay compared to those at the 25th centile (even after excluding those
patients who died prior to discharge). The authors did not comment on potential
reasons for this. Its a bit unexpected. Usually, we see an increase in LOS when
there is an increase in complications. Since kidney and myocardial damage were
identified by lab values, perhaps these were not clinically significant enough
to impact LOS.
The researchers conclude that a large clinical trial to
detect small but clinically significant effects on organ injury and patient
centered outcomes is needed to guide oxygen administration during surgery.
Just one more example that you can have too much of a good
thing. We need to use sound judgement when we use supplemental oxygen in any
setting.
Some of our prior
columns on potential harmful effects of oxygen and other oxygen issues:
April 8, 2008 Oxygen
as a Medication
January 27, 2009 Oxygen
Therapy: Everything You Wanted to Know and More!
April 2009 Nursing Companion to the BTS Oxygen Therapy
Guidelines
October 6, 2009 Oxygen Safety: More Lessons from the UK
July 2010 Cochrane Review: Oxygen in MI
December 6, 2011 Why You Need to Beware of Oxygen Therapy
February 2012 More Evidence of Harm from Oxygen
March 2014 Another Strike Against Hyperoxia
June 17, 2014 SO2S Confirms Routine O2 of No Benefit in
Stroke
December 2014 Oxygen Should Be AVOIDed
August 11, 2015 New Oxygen Guidelines: Thoracic Society of
Australia and NZ
November 2016 Oxygen
Tank Monitoring
November 2016 More
on Safer Use of Oxygen
October 2017 End
of the Oxygen in MI and Stroke Debate?
February 2018 Oxygen
Cylinders Back in the News
June 2018 Too
Much Oxygen
July 2021 Unique
Way to Rapidly Identify Oxygen Flow
References:
McIlroy D R, Shotwell M S, Lopez M G, Vaughn M T, Olsen J S,
Hennessy C et al. Oxygen administration during surgery and postoperative organ
injury: observational cohort study BMJ 2022; 379: e070941
https://www.bmj.com/content/379/bmj-2022-070941
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