Hypercapnia Improves Tissue Oxygenation (original) (raw)
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Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients
Anesthesia and Analgesia, 2006
Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (Fio 2 ) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean patients but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given Fio 2 80% during major abdominal surgery. Thirty obese patients (body mass index 61.5 Ϯ 17 kg/m 2 ) scheduled for open gastric bypass were randomly assigned to normocapnia (n ϭ 15, end-tidal Pco 2 35 mm Hg) or hypercapnia (n ϭ 15, end-tidal Pco 2 50 mm Hg); Fio 2 was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer. Demographic characteristics, cardiovascular measurements, and Pao 2 (222 Ϯ 48 versus 230 Ϯ 68 mm Hg in normocapnic versus hypercapnic; mean Ϯ sd; P ϭ 0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78 Ϯ 31 versus 56 Ϯ 13 mm Hg; P ϭ 0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients.
JAMA, 2005
URGICAL WOUND INFECTIONS prolong hospitalization by an average of 1 week and substantially increase the cost of care. 1,2 These infections are possibly the most common serious complication of surgery and anesthesia. 3 The primary defense against surgical pathogens is oxidative killing by neutrophils. Oxidative killing is a function of tissue oxygen partial pressure throughout the range of observed values. 4 As might be expected, infection risk depends on tissue oxygen partial pressure 5 and, therefore, interventions that increase tissue oxygen may reduce infection risk. Greif et al 6 have shown that providing 80% oxygen throughout surgery and for 2 postoperative hours de-See also p 2091 and Patient Page.
Effect of Supplemental Oxygen on Risk of Surgical Wound Infection
Pakistan Journal of Medical and Health Sciences
Background: There is a risk of different complication after the surgery but delaying in wound healing or infection is one of most common risk. Oxidative killing is a process of tissues partial pressure of oxygen throughout the observed values ranges. The main defense against foreign particles in result of surgery is oxidative killing through neutrophils. In a study by Greif et al4 indicated oxygen 80% during the surgery and after 2 hours later of surgery 50% risk get lesser as compared to the patient who had administrated with 30% oxygen.4 Another study proved that chances of risk for infection get increase in patients who were administrated oxygen 11 % as compared to the patients with 25% oxygen administration.5 The current study was conducted to test the hypothesis that supplemental oxygen decreases the risk of post-operative wound infection. Objective: The objective of the study was to determine the effects of supplemental oxygen on risk of surgical wound infection. Materials and...
The Influence of 2 Surgical Bandage Systems on Wound Tissue Oxygen Tension
Archives of Surgery, 2000
Local wound heating improves tissue oxygen tension in postoperative patients. Setting: University hospital. Patients: Forty normothermic and well-hydrated patients recovering from elective open abdominal surgery. Interventions: A comparison between an experimental bandage system (Warm-Up; Augustine Medical Inc, Eden Prairie, Minn) and conventional gauze covered with elastic adhesive (Medipore Dress-it; 3M, St Paul, Minn). The experimental system is heated to 38°C and does not touch the wound. Main Outcome Measures: Subcutaneous tissue oxygen tension was measured postoperatively and on the first postoperative day. In a subgroup, we also evaluated the effects of bandage pressure per se on tissue oxygen. Results: Initial postoperative tissue oxygen tensions were approximately 30 mm Hg greater with the experimental bandage, even before warming. Subcutaneous oxygen tension during heating remained significantly greater in patients with the warmed bandage than the conventional elastic bandage (116 ± 40 vs 85 ± 34 mm Hg, respectively) while the patients were breathing approximately 50% oxygen. The difference was smaller on the first postoperative day, but still statistically significant (82±30 vs 65±22 mm Hg, respectively). In the subgroup analysis, tissue oxygen tension increased significantly by 12 ± 4 mm Hg when the heating bandage was substituted for a conventional bandage (PϽ.001).
Tissue oxygenation as a target for goal-directed therapy in high-risk surgery: a pilot study
BMC anesthesiology, 2014
Tissue hypoperfusion occurs frequently during surgery and may contribute to postoperative organ dysfunction. There is a need for perioperative treatment protocols aiming at improving tissue oxygenation (StO2). We hypothesised that intra-operative optimisation of StO2 improves tissue perfusion and thus reduces postoperative complications. Furthermore, we evaluated the feasibility of the optimisation algorithm used. We randomized 50 high-risk patients, all >65 years with ASA physical status III, who underwent major abdominal surgery under standardized balanced general anesthesia combined with epidural analgesia. Throughout surgery StO2 was monitored at the thenar eminence using near-infrared spectroscopy. All patients were treated according to a standard care algorithm. In addition, patients in the intervention group were treated with dobutamine if necessary to keep or raise StO2 ≥ 80%. Data were recorded continuously and complications were recorded during hospital stay with a maxi...
Supplemental Oxygen and Risk of Surgical Wound Infection
JAMA, 2006
URGICAL WOUND INFECTIONS prolong hospitalization by an average of 1 week and substantially increase the cost of care. 1,2 These infections are possibly the most common serious complication of surgery and anesthesia. 3 The primary defense against surgical pathogens is oxidative killing by neutrophils. Oxidative killing is a function of tissue oxygen partial pressure throughout the range of observed values. 4 As might be expected, infection risk depends on tissue oxygen partial pressure 5 and, therefore, interventions that increase tissue oxygen may reduce infection risk. Greif et al 6 have shown that providing 80% oxygen throughout surgery and for 2 postoperative hours de-See also p 2091 and Patient Page.
BMC Anesthesiology
Background Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients. Methods Prospective observational study performed at two University Hospitals. Ninety patients undergoing cardiac surgery with ECC were enrolled. The NIRS sensor was applied on the thenar eminence. A vascular occlusion test (VOT, 3-min ischemia) was performed at baseline (t0), at Intensive Care Unit (ICU) admission (t1), 3 (t2) and 6 (t3) hours later. Baseline tissue oxygen saturation (StO2), oxygen extraction rate and microvascular reactivity indices were calculated. Results In the first hours after cardiac surgery, StO2 tended to increase (86% [80–89] at T3 versus 82% [79–86] at T0, p = ns), while both tissue oxygen extraction and microvascular reactivity tended to decrease, as indi...
Association of intraoperative tissue oxygenation with suspected risk factors for tissue hypoxia
Journal of Clinical Monitoring and Computing, 2013
Tissue hypoxia may cause organ dysfunction, but not much is known about tissue oxygenation in the intraoperative setting. We studied microcirculatory tissue oxygen saturation (StO 2 ) to determine representative values for anesthetized patients undergoing urological surgery and to test the hypothesis that StO 2 is associated with known perioperative risk factors for morbidity and mortality, conventionally monitored variables, and hypotension requiring norepinephrine. Using near-infrared spectroscopy, we measured StO 2 on the thenar eminence in 160 patients undergoing open urological surgery under general anesthesia (FiO 2 0.35-0.4), and calculated its correlations with age, risk level for general perioperative complications and mortality (high if age C70 and procedure is radical cystectomy), mean arterial pressure (MAP), hemoglobin concentration (Hb), central venous oxygen saturation (ScvO 2 ), and norepinephrine use. The time averaged StO 2 was 86 ± 6 % (mean ± SD). In the multivariate analysis, Hb [standardized coefficient (SC) 0.21, p = 0.003], ScvO 2 (SC 0.53, p \ 0.001) and high risk level (SC 0.06, p = 0.03) were significant independent variables correlated with StO 2 . StO 2 was partly dependent on MAP only when this was below 65 mmHg (lowest MAP SC 0.20, p = 0.006, MAP area under the curve \65 mmHg SC 0.03, p = 0.02). Finally, StO 2 was slightly lower in patients requiring norepinephrine (85 ± 6 vs. 89 ± 6 %, p = 0.001). Intraoperative StO 2 in urological patients was comparable to that of healthy volunteers breathing room air as reported in the literature and correlated with known perioperative risk factors. Further research should investigate its association with outcome and the effect of interventions aimed at optimizing StO 2 .
Revisited Hyperoxia Pathophysiology in the Perioperative Setting: A Narrative Review
Frontiers in Medicine, 2021
The widespread use of high-dose oxygen, to avoid perioperative hypoxemia along with WHO-recommended intraoperative hyperoxia to reduce surgical site infections, is an established clinical practice. However, growing pathophysiological evidence has demonstrated that hyperoxia exerts deleterious effects on many organs, mainly mediated by reactive oxygen species. The purpose of this narrative review was to present the pathophysiology of perioperative hyperoxia on surgical wound healing, on systemic macro and microcirculation, on the lungs, heart, brain, kidneys, gut, coagulation, and infections. We reported here that a high systemic oxygen supply could induce oxidative stress with inflammation, vasoconstriction, impaired microcirculation, activation of hemostasis, acute and chronic lung injury, coronary blood flow disturbances, cerebral ischemia, surgical anastomosis impairment, gut dysbiosis, and altered antibiotics susceptibility. Clinical studies have provided rather conflicting resu...