Abstract
In perioperative cardiac surgery period, supra-physiological arterial oxygen partial pressures is common practice, although there is no clear evidence of any benefit. Smit et al. have shown that a “conservative” approach did not improve hemodynamics, decrease oxidative stress or myocardial tissue damage, but was not associated with major deleterious event either. Here, we outline major oxygen friend or foes properties, which may partly explain the study results, and place the clinical trial from Smit et al. in a global context.
Highlights
Targeting supra-physiological arterial oxygen partial pressures (PaO2) during the perioperative period of cardiac surgery is common practice [1], but why? The surgical trauma per se and the ischemia–reperfusion sequence associated with cardiopulmonary bypass (CPB) cause hyper-inflammation and excessive release of reactive oxygen species (ROS)
Arterial, and/or tissue hypoxia triggers hyper-inflammation, and cardiac surgery may induce an imbalance between tissue oxygen delivery (DO2) and oxygen consumption (VO2) due to myocardial dysfunction, vasoplegia, microcirculation alterations, hypothermia, anemia, and hypovolemia
Main text Recently, Smit et al [2] investigated whether a “conservative” oxygen approach targeting a “near-physiological” PaO2 of 130–150 and 80–100 mmHg during CPB and in the first 12 hours of ICU stay, respectively, would improve hemodynamics, reduce oxidative stress, and attenuate myocardial damage and visceral organ dysfunction
Summary
Targeting supra-physiological arterial oxygen partial pressures (PaO2) during the perioperative period of cardiac surgery is common practice [1], but why? The surgical trauma per se and the ischemia–reperfusion sequence associated with cardiopulmonary bypass (CPB) cause hyper-inflammation and excessive release of reactive oxygen species (ROS). Arterial, and/or tissue hypoxia triggers hyper-inflammation, and cardiac surgery may induce an imbalance between tissue oxygen delivery (DO2) and oxygen consumption (VO2) due to myocardial dysfunction, vasoplegia, microcirculation alterations, hypothermia, anemia, and hypovolemia. High inspiratory oxygen concentrations (FiO2) can theoretically counteract this problem, but so far the optimal targets for PaO2 during CPB and/or the immediate postoperative ICU stay remain open [1]
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