Effects of Oxygen on Perioperative Vascular Function: A Randomized Clinical Trial.

BACKGROUND

Vascular dysfunction contributes to postoperative organ injury. Exposure to high concentrations of oxygen during surgery is common and may impair vascular function. We tested the hypothesis that hyperoxia during cardiac surgery impairs vascular function compared with normoxia.

METHODS

We recruited and randomly assigned patients having elective cardiac surgery to hyperoxia or normoxia during surgery, measured endothelium-mediated vasodilation via brachial artery flow-mediated dilation and fingertip pulse amplitude tonometry (reactive hyperemia index), assessed endothelium-dependent, endothelium-independent, and heme-independent soluble guanylyl cyclase activator-induced vasodilation ex vivo in mediastinal fat arterioles using wire myography, and quantified plasma markers of vascular function and oxidative stress.

RESULTS

Two hundred participants completed the study. Oxygen treatment did not affect flow-mediated dilation (primary outcome, P=0.377) or reactive hyperemia index (P=0.898). In isolated mediastinal fat arterioles, however, hyperoxia impaired endothelium-independent relaxation (P<0.001) but not endothelium-dependent relaxation (P=0.759) or heme-independent soluble guanylyl cyclase activation (P=0.650). Hyperoxia also increased plasma plasminogen activator inhibitor-1 postoperatively but not e-selectin or syndecan-1. Hyperoxia increased intraoperative concentrations of F2-isoprostanes and isofurans, which were associated with plasminogen activator inhibitor-1 but not other measurements of vascular function.

CONCLUSIONS

Among adults receiving cardiac surgery, intraoperative hyperoxia did not affect endothelium-dependent vasodilation but impaired endothelium-independent vasodilation, likely via soluble guanylyl cyclase heme oxidation. Soluble guanylyl cyclase is a potential therapeutic target to enhance vascular function.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02361944.