Cardiovascular effects of hyperoxia during and after cardiac surgery.
During and after cardiac surgery with cardiopulmonary bypass, high concentrations of oxygen are routinely administered, with the intention of preventing cellular hypoxia. We systematically reviewed the literature addressing the effects of arterial hyperoxia. Extensive evidence from pre-clinical experiments and clinical studies in other patient groups suggests predominant harm, caused by oxidative stress, vasoconstriction, perfusion heterogeneity and myocardial injury. Whether these alterations are temporary and benign, or actually affect clinical outcome, remains to be demonstrated. In nine clinical cardiac surgical studies in low-risk patients, higher oxygen targets tended to compromise cardiovascular function, but did not affect clinical outcome. No data about potential beneficial effects of hyperoxia, such as reduction of gas micro-emboli or post-cardiac surgery infections, were reported. Current evidence is insufficient to specify optimal oxygen targets. Nevertheless, the safety of supraphysiological oxygen suppletion is unproven. Randomised studies with a variety of oxygen targets and inclusion of high-risk patients are needed to identify optimal oxygen targets during and after cardiac surgery.
Department of Intensive Care, VU University Medical Centre, Amsterdam, The Netherlands.
A M E
AM
Spoelstra-de Man
Department of Intensive Care, VU University Medical Centre, Amsterdam, The Netherlands.
B
B
Smit
Department of Intensive Care, VU University Medical Centre, Amsterdam, The Netherlands.
H M
HM
Oudemans-van Straaten
Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
Y M
YM
Smulders
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D018496:Hyperoxia / Q000139:chemically induced* / Q000503:physiopathology; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D018384:Oxidative Stress / Q000502:physiology; D010100:Oxygen / Q000009:adverse effects*; D011184:Postoperative Period; D014661:Vasoconstriction / Q000502:physiology
D010100:Oxygen