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Current Ventilator and Oxygen Management during General Anesthesia: A Multicenter, Cross-sectional Observational
Satoshi Suzuki1, Yuko Mihara, Yukiko Hikasa
1From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan (S.S., Y.M., Y.H., S.O., H.M.) Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan (T.I., A.S.). Atago Hospital, Kochi Chikamori Hospital, Kochi Fukuyama City Hospital, Hiroshima Fukuyama Medical Center, Hiroshima Himeji Central Hospital, Hyogo Hiroshima City Hiroshima Citizens Hospital, Hiroshima Iwakuni Medical Center, Yamaguchi Japanese Red Cross Kobe Hospital, Hyogo Japanese Red Cross Okayama Hospital, Okayama Japanese Red Cross Society Himeji Hospital, Hyogo Japanese Red Cross Society Mihara Hospital, Hiroshima Jichi Medical University Hospital, Tochigi Kagawa Prefectural Central Hospital, Kagawa Kagawa Rosai Hospital, Kagawa Kajiki Hospital, Okayama Kameda Medical Center, Chiba Kawasaki Medical School General Medical Center, Okayama Kawasaki Medical School Hospital, Okayama Kobe University Hospital, Hyogo Kochi Health Sciences Center, Kochi Kochi Medical School Hospital, Kochi Kurashiki Medical Center, Okayama Maizuru Kyosai Hospital, Kyoto Matsuda Hospital, Okayama Mitoyo General Hospital, Kagawa Mizushima Kyodo Hospital, Okayama National Cancer Center Hospital, Tokyo Okayama City Hospital, Okayama Okayama Kyokuto Hospital, Okayama Okayama Kyoritsu General Hospital, Okayama Okayama Medical Center, Okayama Okayama Rosai Hospital, Okayama Okayama Saiseikai General Hospital, Okayama Onomichi Municipal Hospital, Hiroshima Saiseikai Imabari Hospital, Ehime Shizuoka Cancer Center, Shizuoka Showa University Northern Yokohama Hospital, Kanagawa Takasago Municipal Hospital, Hyogo Takinomiya General Hospital, Kagawa Tottori Municipal Hospital, Tottori Tsuyama Chuo Hospital, Okayama Yashima General Hospital, Kagawa.
Background:
Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia.
Methods:
A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%).
Results:
A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60).
Conclusions:
Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.
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