High oxygen concentration exacerbates cardiopulmonary bypass-induced lung injury

• Published in: Journal of cardiothoracic and vascular anesthesia 2000-10, Vol.14 (5), p.519-523
• Main Authors: Pizov, Reuven, Weiss, Yoram G., Oppenheim-Eden, Arieh, Glickman, Hagit, Goodman, Sergey, Koganov, Yevgenei, Barak, Vivian, Merin, Gideon, Kramer, Mordechai R.
• Format: Article
• Language: English
• Subjects: acute lung injury; Biological and medical sciences; bronchoalveolar lavage; Bronchoalveolar Lavage Fluid - immunology; cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; cytokines; Humans; Interleukin-8 - biosynthesis; Medical sciences; Oxygen - toxicity; oxygenation; Prospective Studies; Respiratory Distress Syndrome, Adult - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tumor Necrosis Factor-alpha - biosynthesis
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/jcan.2000.9486

Objective: To investigate the effect of ventilation with 100% oxygen on lung injury associated with surgery involving cardiopulmonary bypass (CPB). Design: A prospective randomized study. Setting: University hospital. Participants: Thirty patients undergoing coronary artery bypass graft surgery with CPB. Interventions: Patients were randomized to receive 100% oxygen (Oxygen group) or 50% oxygen (Air group) throughout surgery. During CPB, patients' lungs in the Air group were flushed with air and in the Oxygen group with 100% oxygen. Measurements and Main Results: Lung injury was evaluated by arterial oxygen tension-inspired oxygen concentration (PaO2-FIO2) ratio and cytokine levels (tumor necrosis factor-α and interleukin-8) in blood and bronchoalveolar lavage fluid measured before and after CPB. The lowest PaO2-FIO2 value was observed after 40 minutes following the completion of CPB in both groups. PaO2-FIO2 values 6 hours after CPB were not different from baseline in the Air group but remained lower (359 ± 63 mmHg and 298 ± 78 mmHg; p = 0.013) in the Oxygen group. Blood cytokine levels rose during surgery in both groups. Bronchoalveolar lavage levels of interleukin-8 did not change, whereas tumor necrosis factor-α increased only in the Oxygen group (p = 0.035). Conclusions: A significant decrease of oxygenation was observed in the early post-CPB period in both groups of patients, with delay in recovery in patients treated with 100% oxygen. A larger increase of the proinflammatory cytokines was found in patients treated with 100% oxygen. High oxygen concentrations during surgery with CPB should be used only when specifically required. Copyright © 2000 by W.B.Saunders Company