title: High oxygen concentration exacerbates cardiopulmonary bypass-induced lung injury.
abstract: OBJECTIVE
  To investigate the effect of ventilation with 100% oxygen on lung injury associated with surgery involving cardiopulmonary bypass (CPB).
  
  
  METHODS
  A prospective randomized study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Thirty patients undergoing coronary artery bypass graft surgery with CPB.
  
  
  METHODS
  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.
  
  
  RESULTS
  Lung injury was evaluated by arterial oxygen tension-inspired oxygen concentration (PaO2-FIO2) ratio and cytokine levels (tumor necrosis factor-alpha 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-alpha 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.
authors.affiliation: Department of Anesthesiology and CCM, Hadassah Medical Center, Jerusalem, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Pizov
authors.forename: Y G
authors.initials: YG
authors.lastname: Weiss
authors.forename: A
authors.initials: A
authors.lastname: Oppenheim-Eden
authors.forename: H
authors.initials: H
authors.lastname: Glickman
authors.forename: S
authors.initials: S
authors.lastname: Goodman
authors.forename: Y
authors.initials: Y
authors.lastname: Koganov
authors.forename: V
authors.initials: V
authors.lastname: Barak
authors.forename: G
authors.initials: G
authors.lastname: Merin
authors.forename: M R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D006801:Humans; D016209:Interleukin-8 / Q000096:biosynthesis; D010100:Oxygen / Q000633:toxicity*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
chemical_list: D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D010100:Oxygen