Anesthesiology research and practice · 2026
Effects of Inspired Oxygen Concentrations During Cardiopulmonary Bypass on the Pulmonary Function of Patients Undergoing a Modified Morrow Procedure via a Small Right Axillary Incision.
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Xu Linting, Wang Lixin, Yan Meijuan, Wei Hanwei, Jiang Tian, Wang Haozhou, Guo Jinchen, Cui Yong
Аннотация
BACKGROUND: Patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing minimally invasive modified Morrow procedure may be vulnerable to postoperative pulmonary dysfunction. During cardiopulmonary bypass (CPB), lung-protective ventilation has been proposed, but the optimal inspired oxygen concentration under this strategy remains unclear. This study aimed to compare different inspired oxygen concentrations under a fixed lung-protective ventilation strategy during CPB.
METHODS: This was a prospective clinical observation study involving 97 patients scheduled for modified Morrow procedures via a small right axillary incision between January 2023 and November 2023 at a single center. Patients were randomized to receive CPB ventilation with FiO2 of 30%, 50%, or 100% under a standardized ultra-low-tidal-volumelung-protective strategy. The primary outcomes included the Horowitz Index (HI = PaO2/FiO2), respiratory index (RI = P(A-a)O2/PaO2), and alveolar-arterial oxygen pressure difference [P(A-a)O2] at six different time points within the first 24 h postoperatively, as well as postoperative pulmonary complications. Secondary outcomes included plasma levels of inflammatory cytokines, endothelial glycocalyx (eGC) components, and measures of postoperative rehabilitation and other complications.
RESULTS: There were no significant differences in terms of postoperative complications and rehabilitation among the three groups with different inspired oxygen concentrations under a fixed lung-protective ventilation strategy during CPB. Compared with the 100% FiO2 group, the 30% FiO2 group exhibited higher HI at 6 h and 24 h postoperatively with lower P(A-a)O2 at 18 h and 24 h postoperatively and a lower RI at 24 h postoperatively. In addition, the 30% FiO2 group showed lower plasma levels of inflammatory cytokines and eGC.
CONCLUSION: These findings indicate that the use of 30% 100% FiO2 group with ultra-low tidal volume ventilation during CPB in patients undergoing a modified Morrow procedure via a small right axillary incision was safe and associated with improved early postoperative oxygenation and attenuated inflammatory response. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2400084443.
METHODS: This was a prospective clinical observation study involving 97 patients scheduled for modified Morrow procedures via a small right axillary incision between January 2023 and November 2023 at a single center. Patients were randomized to receive CPB ventilation with FiO2 of 30%, 50%, or 100% under a standardized ultra-low-tidal-volumelung-protective strategy. The primary outcomes included the Horowitz Index (HI = PaO2/FiO2), respiratory index (RI = P(A-a)O2/PaO2), and alveolar-arterial oxygen pressure difference [P(A-a)O2] at six different time points within the first 24 h postoperatively, as well as postoperative pulmonary complications. Secondary outcomes included plasma levels of inflammatory cytokines, endothelial glycocalyx (eGC) components, and measures of postoperative rehabilitation and other complications.
RESULTS: There were no significant differences in terms of postoperative complications and rehabilitation among the three groups with different inspired oxygen concentrations under a fixed lung-protective ventilation strategy during CPB. Compared with the 100% FiO2 group, the 30% FiO2 group exhibited higher HI at 6 h and 24 h postoperatively with lower P(A-a)O2 at 18 h and 24 h postoperatively and a lower RI at 24 h postoperatively. In addition, the 30% FiO2 group showed lower plasma levels of inflammatory cytokines and eGC.
CONCLUSION: These findings indicate that the use of 30% 100% FiO2 group with ultra-low tidal volume ventilation during CPB in patients undergoing a modified Morrow procedure via a small right axillary incision was safe and associated with improved early postoperative oxygenation and attenuated inflammatory response. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2400084443.