Abstract：
OBJECTIVE: To estimate the incidence of postoperative oxygenation impairment after lung resection in the era of lung-protective management, and to identify perioperative factors associated with that impairment.
METHODS: Registry-based retrospective cohort study.
METHODS: Two large academic hospitals in the United States.
METHODS: 3081 ASA I-IV patients undergoing lung resection.
METHODS: 79 pre- and intraoperative variables, selected for inclusion based on a causal inference framework. The primary outcome of impaired oxygenation, an early marker of lung injury, was defined as at least one of the following within seven postoperative days: (1) SpO2 < 92%; (2) imputed PaO2/FiO2 < 300 mmHg [(1) or (2) occurring at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50% oxygen or high-flow oxygen).
RESULTS: Oxygenation was impaired within seven postoperative days in 70.8% of patients (26.6% with PaO2/FiO2 < 200 mmHg or intensive oxygen therapy). In multivariable analysis, each additional cmH2O of intraoperative median driving pressure was associated with a 7% higher risk of impaired oxygenation (OR 1.07; 95%CI 1.04 to 1.10). Higher median intraoperative FiO2 (OR 1.23; 95%CI 1.14 to 1.31 per 0.1) and PEEP (OR 1.12; 95%CI 1.04 to 1.21 per 1 cm H2O) were also associated with increased risk. History of COPD (OR 2.55; 95%CI 1.95 to 3.35) and intraoperative albuterol administration (OR 2.07; 95%CI 1.17 to 3.67) also showed reliable effects.
CONCLUSIONS: Impaired postoperative oxygenation is common after lung resection and is associated with potentially modifiable pre- and intraoperative respiratory factors.
METHODS: Registry-based retrospective cohort study.
METHODS: Two large academic hospitals in the United States.
METHODS: 3081 ASA I-IV patients undergoing lung resection.
METHODS: 79 pre- and intraoperative variables, selected for inclusion based on a causal inference framework. The primary outcome of impaired oxygenation, an early marker of lung injury, was defined as at least one of the following within seven postoperative days: (1) SpO2 < 92%; (2) imputed PaO2/FiO2 < 300 mmHg [(1) or (2) occurring at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50% oxygen or high-flow oxygen).
RESULTS: Oxygenation was impaired within seven postoperative days in 70.8% of patients (26.6% with PaO2/FiO2 < 200 mmHg or intensive oxygen therapy). In multivariable analysis, each additional cmH2O of intraoperative median driving pressure was associated with a 7% higher risk of impaired oxygenation (OR 1.07; 95%CI 1.04 to 1.10). Higher median intraoperative FiO2 (OR 1.23; 95%CI 1.14 to 1.31 per 0.1) and PEEP (OR 1.12; 95%CI 1.04 to 1.21 per 1 cm H2O) were also associated with increased risk. History of COPD (OR 2.55; 95%CI 1.95 to 3.35) and intraoperative albuterol administration (OR 2.07; 95%CI 1.17 to 3.67) also showed reliable effects.
CONCLUSIONS: Impaired postoperative oxygenation is common after lung resection and is associated with potentially modifiable pre- and intraoperative respiratory factors.
摘要：
目的：评估肺保护性治疗时代肺切除术后氧合损伤的发生率，并确定与损伤相关的围手术期因素。
方法：基于注册表的回顾性队列研究。
方法：美国两家大型学术医院。
方法：3081名接受肺切除术的ASAI-IV患者。
方法：79个术前和术中变量，基于因果推理框架选择纳入。氧合受损的主要结果，肺损伤的早期标志,定义为术后7天内至少有以下情况之一：（1）SpO2<92％；（2）估算的PaO2/FiO2<300mmHg[（1）或（2）在24小时内至少发生两次]；（3）强化氧气治疗（机械通气或>50％氧气或高流量氧气）。
结果：70.8%的患者在术后7天内氧合受损（26.6%PaO2/FiO2<200mmHg或强化氧疗）。在多变量分析中，术中中位驱动压每增加cmH2O与氧合受损风险增加7%相关(OR1.07;95CI1.04~1.10).术中FiO2中位数较高（OR1.23;95CI1.14至1.31/0.1）和PEEP（OR1.12;95CI1.04至1.21/1cmH2O）也与风险增加相关。COPD病史（OR2.55；95CI1.95至3.35）和术中服用沙丁胺醇（OR2.07；95CI1.17至3.67）也显示出可靠的效果。
结论：术后氧合受损在肺切除术后很常见，并且与可能改变的术前和术中呼吸因素有关。
方法：基于注册表的回顾性队列研究。
方法：美国两家大型学术医院。
方法：3081名接受肺切除术的ASAI-IV患者。
方法：79个术前和术中变量，基于因果推理框架选择纳入。氧合受损的主要结果，肺损伤的早期标志,定义为术后7天内至少有以下情况之一：（1）SpO2<92％；（2）估算的PaO2/FiO2<300mmHg[（1）或（2）在24小时内至少发生两次]；（3）强化氧气治疗（机械通气或>50％氧气或高流量氧气）。
结果：70.8%的患者在术后7天内氧合受损（26.6%PaO2/FiO2<200mmHg或强化氧疗）。在多变量分析中，术中中位驱动压每增加cmH2O与氧合受损风险增加7%相关(OR1.07;95CI1.04~1.10).术中FiO2中位数较高（OR1.23;95CI1.14至1.31/0.1）和PEEP（OR1.12;95CI1.04至1.21/1cmH2O）也与风险增加相关。COPD病史（OR2.55；95CI1.95至3.35）和术中服用沙丁胺醇（OR2.07；95CI1.17至3.67）也显示出可靠的效果。
结论：术后氧合受损在肺切除术后很常见，并且与可能改变的术前和术中呼吸因素有关。
