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Muscular tissue desaturation and pneumonia in patients receiving lung cancer surgery: a cohort study
Wei Zhao1, Caijuan Zhang1,2,3, Dongliang Mu2
1Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.
Background:
Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.
Methods:
This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO 2 ) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO 2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO 2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression. The secondary outcome was the correlation between SmtO 2 in the forearm and that in the thigh.
Results:
We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO 2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center.
Conclusion:
Muscular tissue desaturation, defined as a baseline SmtO 2 < 80% in the forearm, may be associated with an increased risk of POP.
Trial Registration:
No. ChiCTR-ROC-17012627.
Insights
Intra-operative muscular tissue desaturation, defined as low forearm oxygen saturation, may predict post-operative pneumonia in lung cancer surgery patients. This finding highlights a potential new monitoring tool for surgical risk.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Post-operative pneumonia (POP) is a significant complication following lung cancer surgery.
- Muscular tissue oxygenation is implicated in post-operative complications, but its direct link to POP after lung cancer surgery is understudied.
- This research explores intra-operative muscular tissue desaturation as a potential predictor for POP.
Purpose of the Study:
- To investigate the association between intra-operative muscular tissue desaturation and the occurrence of post-operative pneumonia in patients undergoing lung cancer surgery.
- To evaluate muscular tissue oxygen saturation (SmtO 2) monitoring as a potential biomarker for predicting POP.
Main Methods:
- A cohort study involving 174 patients (≥55 years) who underwent lobectomy with one-lung ventilation.
- Intra-operative muscular tissue oxygen saturation (SmtO 2) was monitored in the forearm and thigh.
- Muscular tissue desaturation was defined as a minimum SmtO 2 of <80% for >15 seconds; multivariable logistic regression analyzed its association with POP.
Main Results:
- The incidence of muscular desaturation (forearm SmtO 2 <80%) was 47.1%.
- Patients experiencing muscular desaturation had a significantly higher incidence of pneumonia (28.0% vs. 12.0%, P=.008).
- Muscular desaturation was independently associated with an increased risk of POP (OR: 2.995, P=.035) after adjusting for multiple clinical factors.
Conclusions:
- Intra-operative muscular tissue desaturation, specifically a baseline forearm SmtO 2 <80%, is potentially associated with an elevated risk of post-operative pneumonia.
- This finding suggests that monitoring muscular tissue oxygenation during surgery could aid in identifying patients at higher risk for POP.
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