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Avoidance of Hyperoxemia Versus Routine Hyperoxia During Cardiopulmonary Bypass in Children With Cyanotic Congenital

Johannes Fischer1, Ayodeji Arobo2, Abdullah Almehandi3

  • 1Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany.

Paediatric Anaesthesia
|March 25, 2026
PubMed

Insights

Avoiding hyperoxemia during cardiac surgery in children with cyanotic congenital heart disease did not significantly reduce postoperative intubation time or other key outcomes compared to routine hyperoxic management. Further research may be needed to clarify optimal oxygenation strategies.

Area of Science:

  • Pediatric Cardiac Surgery
  • Critical Care Medicine
  • Cardiopulmonary Bypass

Background:

  • Children with cyanotic congenital heart disease undergoing cardiopulmonary bypass (CPB) face uncertain optimal oxygenation strategies.
  • The impact of limiting hyperoxic exposure during CPB in this population remains unclear.

Purpose of the Study:

  • To compare oxygenation strategies designed to avoid hyperoxemia versus routine hyperoxic management in pediatric patients undergoing cardiac surgery with CPB.
  • To evaluate the effect of different oxygenation strategies on postoperative outcomes.

Main Methods:

  • A systematic literature search was performed across four databases.
  • Included studies were analyzed using a random-effects model to calculate standardized mean differences and odds ratios for various outcomes.
  • Primary outcome was postoperative intubation time; secondary outcomes included ICU and hospital length of stay, operative duration, and epinephrine requirement.

Main Results:

  • Seven studies (six RCTs, one observational) were included in the meta-analysis.
  • Strategies avoiding hyperoxemia showed no significant reduction in postoperative intubation time compared to routine hyperoxia (SMD: -0.25; 95% CI: -0.52-0.03; p=0.077).
  • No significant differences were found for ICU LOS, hospital LOS, operative duration, or epinephrine use between the groups.

Conclusions:

  • Current evidence suggests no significant difference in postoperative outcomes between avoiding hyperoxemia and routine hyperoxic management during CPB in children with cyanotic congenital heart disease.
  • The optimal oxygenation strategy in this vulnerable patient group requires further investigation.
Abstract

Keywords:
cardiopulmonary bypasscongenital cardiac surgerycyanotic congenital heart diseasehyperoxemiahyperoxia

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