Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.2906 Dr. Marcos G. Lopez et al.
Points
- A randomized clinical trial investigated the impact of intraoperative hyperoxia versus normoxia on oxidative stress and postoperative organ dysfunction in 200 patients undergoing elective open cardiac surgery.
- Patients receiving hyperoxia (100% inspired oxygen) showed a significant increase in oxidative stress markers during surgery compared to those receiving normoxia.
- Despite the increase in oxidative stress, there was no significant difference in the primary clinical endpoint of serum creatinine changes or the incidence of acute kidney injury (AKI) between the hyperoxia and normoxia groups.
- The incidence of AKI was equal in both groups, with 21% of patients affected, and there were no significant differences in other organ dysfunctions, such as delirium, myocardial injury, or atrial fibrillation.
- The study concluded that while hyperoxia increases oxidative stress during cardiac surgery, it does not affect the rate of postoperative kidney injury or other significant organ dysfunctions, suggesting that oxygen level adjustments may not impact long-term organ health outcomes.
Summary
In a randomized clinical trial conducted at a tertiary care medical center from April 2016 to October 2020, researchers evaluated the effects of intraoperative hyperoxia versus normoxia on oxidative stress and postoperative organ dysfunction in 200 adult patients undergoing elective open cardiac surgery. Patients were randomized to receive either hyperoxia (100% inspired oxygen) or normoxia (minimum inspired oxygen to maintain arterial oxygen saturation between 95%-97%). The study primarily monitored levels of F2-isoprostanes and isofurans, indicators of oxidative stress, and assessed the incidence of acute kidney injury (AKI) and other organ dysfunctions postoperatively.
Results revealed that during surgery, patients assigned to hyperoxia experienced a significant increase in oxidative stress markers from a baseline median of 73.3 pg/mL to 85.5 pg/mL upon ICU admission, with a peak increase of 9.2 pg/mL (95% CI, 1.0-17.4; P = .03) compared to the normoxia group. However, there was no significant difference in the primary clinical endpoint of serum creatinine changes from baseline to postoperative day 2 between the hyperoxia and normoxia groups, with median changes of 0.01 mg/dL and -0.01 mg/dL respectively (median difference, 0.03; 95% CI, -0.04 to 0.10; P = .45). The incidence of AKI was equal in both groups at 21%.
The study concluded that while intraoperative hyperoxia increases oxidative stress during cardiac surgery, it does not influence the rate of postoperative kidney injury or other significant organ dysfunctions such as delirium, myocardial injury, and atrial fibrillation. These findings suggest adjusting oxygen levels during cardiac surgery may not impact long-term organ health outcomes. This trial is registered under ClinicalTrials.gov Identifier: NCT02361944.
Link to the article: https://jamanetwork.com/journals/jamasurgery/article-abstract/2821958
References Lopez, M. G., Shotwell, M. S., Hennessy, C., Pretorius, M., McIlroy, D. R., Kimlinger, M. J., Mace, E. H., Absi, T., Shah, A. S., Brown, N. J., Billings, F. T., IV, & ROCS trial investigators. (2024). Intraoperative Oxygen Treatment, Oxidative Stress, and Organ Injury Following Cardiac Surgery: A Randomized Clinical Trial. JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.2906
