Oxygen reserve index guided fraction of inspired oxygen titration to reduce hyperoxemia during laparoscopic gastrectomy: A randomized controlled trial

Jin Hee Ahn, Jae-Geum Shim, Jiyeon Park, Sung Hyun Lee, Kyoung-Ho Ryu, Eun-Ah Cho, Jin Hee Ahn, Jae-Geum Shim, Jiyeon Park, Sung Hyun Lee, Kyoung-Ho Ryu, Eun-Ah Cho

Abstract

Background: The usefulness of the oxygen reserve index (ORi) in reducing hyperoxemia remains unclear. We designed this study to investigate whether fraction of inspired oxygen (FiO2) adjustment under a combination of ORi and peripheral oxygen saturation (SpO2) guidance can reduce intraoperative hyperoxemia compared to SpO2 alone.

Methods: In this prospective, double-blind, randomized controlled study, we allocated patients scheduled for laparoscopic gastrectomy to the SpO2 group (FiO2 adjusted to target SpO2 ≥ 98%) or the ORi-SpO2 group (FiO2 adjusted to target 0 < 0 ORi < .3 and SpO2 ≥ 98%). The ORi, SpO2, FiO2, arterial partial pressure of oxygen (PaO2), and incidence of severe hyperoxemia (PaO2 ≥ 200 mm Hg) were recorded before and 1, 2, and 3 hours after surgical incision. Data from 32 and 30 subjects in the SpO2 and ORi-SpO2 groups, respectively, were analyzed.

Results: PaO2 was higher in the SpO2 group (250.31 ± 57.39 mm Hg) than in the ORi-SpO2 group (170.07 ± 49.39 mm Hg) 1 hour after incision (P < .001). PaO2 was consistently higher in the SpO2 group than in the ORi-SpO2 group, over time (P = .045). The incidence of severe hyperoxemia was higher in the SpO2 group (84.4%) than in the ORi-SpO2 group (16.7%, P < .001) 1 hour after incision. Higher FiO2 was administered to the SpO2 group [52.5 (50-60)] than the ORi-SpO2 group [40 (35-50), P < .001] 1 hour after incision. SpO2 was not different between the 2 groups.

Conclusion: The combination of ORi and SpO2 guided FiO2 adjustment reduced hyperoxemia compared to SpO2 alone during laparoscopic gastrectomy.

Trial registration: ClinicalTrials.gov NCT04211246.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1.
Figure 1.
CONSORT diagram of the present study.
Figure 2.
Figure 2.
Diagram describing the change of incidence of severe hyperoxemia (A), fraction of inspired oxygen (B), partial pressure of arterial oxygen (C), and oxygen reserve index (D) before surgical incision (time 0) and 1 h (time 1), 2 h (time 2), and 3 h (time 3) after surgical incision in each group. *P < .05, post hoc test at each time point. †P < .05 by Brunner & Langer’s method. ‡P < .05 by linear mixed model.

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Source: PubMed

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