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Kim EH, Park JB, Kang P, Ji SH, Jang YE, Lee JH, Kim HS, Kim JT. Oxygen reserve index versus conventional peripheral oxygen saturation for prevention of hypoxaemia: A randomised controlled trial. Eur J Anaesthesiol 2024; 41:687-694. [PMID: 39087414 DOI: 10.1097/eja.0000000000002018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Hypoxaemia occurs frequently during paediatric laryngeal microsurgery. OBJECTIVE The oxygen reserve index is a noninvasive and continuous parameter to assess PaO2 levels in the range of 100 to 200 mmHg. It ranges from 0 to 1.0. We investigated whether monitoring the oxygen reserve index can reduce the incidence of SpO2 90% or less. DESIGN Randomised controlled trial. SETTING A tertiary care paediatric hospital. PARTICIPANTS Paediatric patients aged 18 years or less scheduled to undergo laryngeal microsurgery. INTERVENTION The patients were randomly allocated to the oxygen reserve index or control groups, and stratified based on the presence of a tracheostomy tube. Rescue intervention was performed when the oxygen reserve index was 0.2 or less and the SpO2 was 94% or less in the oxygen reserve index and control groups, respectively. MAIN OUTCOME MEASURE The primary outcome was the incidence of SpO2 90% or less during the surgery. RESULTS Data from 88 patients were analysed. The incidence of SpO2 ≤ 90% did not differ between the oxygen reserve index and control groups [P = 0.114; 11/44, 25% vs. 18/44, 40.9%; relative risk: 1.27; and 95% confidence interval (CI): 0.94 to 1.72]. Among the 128 rescue interventions, SpO2 ≤ 90% event developed in 18 out of 75 events (24%) and 42 out of 53 events (79.2%) in the oxygen reserve index and control groups, respectively (P < 0.001; difference: 55.2%; and 95% CI 38.5 to 67.2%). The number of SpO2 ≤ 90% events per patient in the oxygen reserve index group (median 0, maximum 3) was less than that in the control group (median 0, maximum 8, P = 0.031). CONCLUSION Additional monitoring of the oxygen reserve index, with a target value of greater than 0.2 during paediatric airway surgery, alongside peripheral oxygen saturation, did not reduce the incidence of SpO2 ≤ 90%.
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Affiliation(s)
- Eun-Hee Kim
- From the Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea (E-HK, J-BP, PK, S-HJ, Y-EJ, J-HL, H-SK, J-TK)
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Ji SH, Park JB, Kang P, Jang YE, Kim EH, Lee JH, Kim HS, Kim JT. Effect of high-flow nasal and buccal oxygenation on safe apnea time in children with open mouth: A randomized controlled trial. Paediatr Anaesth 2024. [PMID: 39193638 DOI: 10.1111/pan.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND High-flow nasal oxygenation is reported to prolong duration of apnea while maintaining adequate oxygen saturation with the mouth closed. Also, buccal oxygenation is known to have similar effects in obese adults. We compared the effect of these two methods on prolongation of acceptable apnea time in pediatric patients with their mouth open. METHODS Thirty-eight patients, aged 0-10 years were randomly allocated to either the high-flow nasal oxygenation group (n = 17) or the buccal oxygenation group (n = 21). After induction of anesthesia including neuromuscular blockade, manual ventilation was initiated until the expiratory oxygen concentration reached 90%. Subsequently, ventilation was paused, and the patient's head was extended, and mouth was opened. The HFNO group received 2 L·min-1·kg-1 of oxygen, and the BO group received 0.5 L·min-1·kg-1 of oxygen. We set a target apnea time according to previous literature. When the apnea time reached the target, we defined the case as "success" in prolongation of safe apnea time and resumed ventilation. When the pulse oximetry decreased to 92% before the target apnea time, it was recorded as "failure" and rescue ventilation was given. RESULTS The success rate of safe apnea prolongation was 100% in the high-flow nasal oxygenation group compared to 76% in the buccal oxygenation group (p = .04). Oxygen reserve index, end-tidal or transcutaneous carbon dioxide partial pressure, and pulse oximetry did not differ between groups. CONCLUSION High-flow nasal oxygenation is effective in maintaining appropriate arterial oxygen saturation during apnea even in children with their mouth open and is superior to buccal oxygenation. Buccal oxygenation may be a good alternative when high-flow nasal oxygenation is not available.
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Affiliation(s)
- Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Li H, Liu J, Xiong L, Duan G, Xu Y. Oxygen concentration titration guided by oxygen reserve index during pediatric laryngeal surgery with high-flow nasal cannula oxygen: a randomized controlled trial. J Anesth 2024; 38:508-515. [PMID: 38805073 DOI: 10.1007/s00540-024-03348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The objective of this study was to evaluate whether adjusting the oxygen concentration guided by the Oxygen Reserve Index (ORI) during pediatric laryngeal surgery with High Flow Nasal Cannula Oxygen (HFNO) could achieve postoperative PaO2 close to physiological levels while ensuring adequate oxygenation in surgery. METHODS Sixty pediatric patients undergoing laryngeal surgery or examination were randomly assigned to two groups. The ORI group received oxygen concentration adjustments every 5 min to maintain a target ORI value of 0.21, whereas the control group did not undergo any adjustments. Postoperative PaO2, time weighted average fraction of inspired oxygen (FiO2), and mean Peripheral Oxygen Saturation (SpO2) were compared between groups. Finally, some analyses were conducted to examine the relationship of ORI with PaO2. RESULTS In general, the postoperative PaO2 was 164.9 ± 48.8 mmHg in ORI group and 323.0 ± 87.7 mmHg in control group (P < 0.01). The time weighted average FiO2 in the ORI group was 85.9 [81.8-92.7] %. There was no significant difference in mean SpO2 between the two groups (ORI vs. control: 98.4 [97.7-99.2] vs. 98.8 [97.7-99.5]; P = 0.36). According to the analyses, the optimal cut value for ORI was determined to be 0.195 when PaO2 was 150 mmHg. CONCLUSIONS In pediatric laryngeal surgery with HFNO, reducing oxygen concentration guided by ORI helped achieve postoperative PaO2 levels closer to physiological norms without compromising intra-operative oxygenation.
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Affiliation(s)
- Haisu Li
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China
| | - Jianxia Liu
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China
| | - Ling Xiong
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Ying Xu
- Department of Anesthesiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People's Republic of China.
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, 400014, People's Republic of China.
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Zanusso F, De Benedictis GM, Bellini L. Exploring oxygen reserve index for timely detection of deoxygenation in canine patients recovering from anesthesia. Res Vet Sci 2024; 173:105268. [PMID: 38631076 DOI: 10.1016/j.rvsc.2024.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
Pulse oximetry (SpO2) identifies a decrease in the partial pressure of oxygen (PaO2) when it falls below 80 mmHg, while oxygen reserve index (ORi), a dimensionless index ranging from 0 to 1, detects PaO2 changes between 100 and 200 mmHg. This study investigates the usefulness of ORi in detecting impending deoxygenation before traditional SpO2. Fifty-one dogs undergoing anesthesia were mechanically ventilated maintaining a fraction of inspired oxygen of 0.50 and an ORi of 1. Animals were classified according to their body condition score (BCS) as normal-fit (BCS 4-5/9), overweight (BCS 6-7/9), or obese (BCS 8-9/9). At the end of the procedure, dogs were placed in sternal recumbency, and after 10 min disconnected from the ventilator and maintained in apnea. ORi added warning time was determined at various ORi values as the time difference in reaching SpO2 of 95% from ORi of 0.9 and 0.5, compared to the SpO2 warning time from SpO2 of 98%. During apnea, ORi decreased before noticeable SpO2 changes. An ORi of 0.9 anticipated an SpO2 of 95% in normal-fit dogs by 87 (33-212) [median (range)] seconds or in those with a BCS ≥ 6/9 by 49 (7-161) seconds. Regardless of the BCS class, the median time from ORi of 0.5 to SpO2 of 95% was 30-35 s. ORi declined from 0.9 to 0.0 in 68 compared to 33 s between normal-fit and obese dogs (p < 0.05). In dogs, ORi added warning time could facilitate timely intervention, particularly in obese patients.
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Affiliation(s)
- Francesca Zanusso
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy
| | - Giulia Maria De Benedictis
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy
| | - Luca Bellini
- Department of Animal Medicine, Productions and Health, School of Agricultural Sciences and Veterinary Medicine, University of Padova, Legnaro 35020, Padova, Italy.
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van Wijk JJ, Musaj A, Hoeks SE, Reiss IKM, Stolker RJ, Staals LM. Oxygenation during general anesthesia in pediatric patients: A retrospective observational study. J Clin Anesth 2024; 94:111406. [PMID: 38325249 DOI: 10.1016/j.jclinane.2024.111406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/17/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE Protocols are used in intensive care and emergency settings to limit the use of oxygen. However, in pediatric anesthesiology, such protocols do not exist. This study aimed to investigate the administration of oxygen during pediatric general anesthesia and related these values to PaO2, SpO2 and SaO2. DESIGN Retrospective observational study. SETTING Tertiary pediatric academic hospital, from June 2017 to August 2020. PATIENTS Patients aged 0-18 years who underwent general anesthesia for a diagnostic or surgical procedure with tracheal intubation and an arterial catheter for regular blood withdrawal were included. Patients on cardiopulmonary bypass or those with missing data were excluded. Electronic charts were reviewed for patient characteristics, type of surgery, arterial blood gas analyses, and oxygenation management. INTERVENTIONS No interventions were done. MEASUREMENTS Primary outcome defined as FiO2, PaO2 and SpO2 values were interpreted using descriptive analyses, and the correlation between PaO2 and FiO2 was determined using the weighted Spearman correlation coefficient. MAIN RESULTS Data of 493 cases were obtained. Of these, 267 were excluded for various reasons. Finally, 226 cases with a total of 645 samples were analyzed. The median FiO2 was 36% (IQR 31 to 43), with a range from 20% to 97%, and the median PaO2 was 23.6 kPa (IQR 18.6 to 28.1); 177 mmHg (IQR 140 to 211). The median SpO2 level was 99% (IQR 98 to 100%). The study showed a moderately positive association between PaO2 and FiO2 (r = 0.52, p < 0.001). 574 of 645 samples (89%) contained a PaO2 higher than 13.3 kPa; 100 mmHg. CONCLUSIONS Oxygen administration during general pediatric anesthesia is barely regulated. Hyperoxemia is observed intraoperatively in approximately 90% of cases. Future research should focus on outcomes related to hyperoxemia.
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Affiliation(s)
- Jan J van Wijk
- Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Albina Musaj
- Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sanne E Hoeks
- Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Lonneke M Staals
- Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Ryu JH, Jeon YT, Sim KM, Lee S, Oh AY, Koo CH. Role of oxygen reserve index monitoring in patients undergoing robot-assisted radical prostatectomy: a retrospective study. World J Urol 2024; 42:232. [PMID: 38613597 PMCID: PMC11015992 DOI: 10.1007/s00345-024-04938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/20/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE Robot-assisted radical prostatectomy (RARP) is a common surgical procedure for the treatment of prostate cancer. Although beneficial, it can lead to intraoperative hypoxia due to high-pressure pneumoperitoneum and Trendelenburg position. This study explored the use of oxygen reserve index (ORi) to monitor and predict hypoxia during RARP. METHODS A retrospective analysis was conducted on 329 patients who underwent RARP at the Seoul National University Bundang Hospital between July 2021 and March 2023. Various pre- and intraoperative variables were collected, including ORi values. The relationship between ORi values and hypoxia occurrence was assessed using receiver operating characteristic curves and logistic regression analysis. RESULTS Intraoperative hypoxia occurred in 18.8% of the patients. The receiver operating characteristic curve showed a satisfactory area under the curve of 0.762, with the ideal ORi cut-off value for predicting hypoxia set at 0.16. Sensitivity and specificity were 64.5% and 75.7%, respectively. An ORi value of < 0.16 and a higher body mass index were identified as independent risk factors of hypoxia during RARP. CONCLUSIONS ORi monitoring provides a non-invasive approach to predict intraoperative hypoxia during RARP, enabling early management. Additionally, the significant relationship between a higher body mass index and hypoxia underscores the importance of individualized patient assessment.
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Affiliation(s)
- Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Kyu Man Sim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Soowon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.
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Lee J, Chung M, Sung ES, Yoon JP, Yoo YM, Bae J, Kim HY. Use of oxygen reserve index during bronchoscopic balloon dilation for subglottic stenosis in a patient with left ventricular assist device implantation -a case report. Korean J Anesthesiol 2024; 77:273-277. [PMID: 37814398 PMCID: PMC10982534 DOI: 10.4097/kja.23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Monitoring the oxygenation status is crucial during general anesthesia to ensure patient safety. Although noninvasive pulse oximetry is commonly used to monitor percutaneous oxygen saturation (SpO2), it may not accurately reflect changes in oxygen partial pressure when the latter is excessively high or low. The oxygen reserve index (ORi) provides real-time information about the oxygen reserve status. CASE We present a case of successful management of subglottic stenosis using balloon bronchoscopy in an infant with a left ventricular assist device implantation under ORi monitoring to predict hypoxemia during the surgical procedure. CONCLUSIONS Utilizing ORi monitoring during anesthesia for procedures involving apnea in critically ill infants can help predict impending desaturation before a drop in SpO2 occurs, allowing anesthesiologists to effectively anticipate and manage the apnea period. Continuous ORi monitoring offers valuable insights during surgical procedures, especially in infants with compromised respiratory and cardiovascular functions.
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Affiliation(s)
- Jimin Lee
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Minwoo Chung
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eui-Suk Sung
- Department of Otolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
| | - Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Yeong Min Yoo
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Jaesang Bae
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
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Abstract
The monitoring of vital signs in patients undergoing anesthesia began with the very first case of anesthesia and has evolved alongside the development of anesthesiology ever since. Patient monitoring started out as a manually performed, intermittent, and qualitative assessment of the patient's general well-being in the operating room. In its evolution, patient monitoring development has responded to the clinical need, for example, when critical incident studies in the 1980s found that many anesthesia adverse events could be prevented by improved monitoring, especially respiratory monitoring. It also facilitated and perhaps even enabled increasingly complex surgeries in increasingly higher-risk patients. For example, it would be very challenging to perform and provide anesthesia care during some of the very complex cardiovascular surgeries that are almost routine today without being able to simultaneously and reliably monitor multiple pressures in a variety of places in the circulatory system. Of course, anesthesia patient monitoring itself is enabled by technological developments in the world outside of the operating room. Throughout its history, anesthesia patient monitoring has taken advantage of advancements in material science (when nonthrombogenic polymers allowed the design of intravascular catheters, for example), in electronics and transducers, in computers, in displays, in information technology, and so forth. Slower product life cycles in medical devices mean that by carefully observing technologies such as consumer electronics, including user interfaces, it is possible to peek ahead and estimate with confidence the foundational technologies that will be used by patient monitors in the near future. Just as the discipline of anesthesiology has, the patient monitoring that accompanies it has come a long way from its beginnings in the mid-19th century. Extrapolating from careful observations of the prevailing trends that have shaped anesthesia patient monitoring historically, patient monitoring in the future will use noncontact technologies, will predict the trajectory of a patient's vital signs, will add regional vital signs to the current systemic ones, and will facilitate directed and supervised anesthesia care over the broader scope that anesthesia will be responsible for.
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Affiliation(s)
- Kai Kuck
- From the Departments of Anesthesiology and Biomedical Engineering, University of Utah, Salt Lake City, Utah
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Watanabe T, Kanno N, Suzuki S, Yogo T, Harada Y, Hara Y. Investigation of the association between oxygen reserve index and arterial partial oxygen pressure in anesthetized dogs. Vet Anaesth Analg 2024; 51:10-15. [PMID: 37949743 DOI: 10.1016/j.vaa.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the relationship between oxygen reserve index (ORI) and arterial partial pressure of oxygen (PaO2) in anesthetized dogs. STUDY DESIGN Prospective experimental study. ANIMALS A total of eight healthy adult Beagle dogs with a median age of 38 (range 20-87) months and a median body mass of 8.6 (range 7.0-13.8) kg. METHODS After induction of general anesthesia with propofol, dogs were mechanically ventilated and anesthesia maintained with isoflurane carried in oxygen. Arterial blood samples were collected from a catheter placed in the femoral artery. ORI was measured by placing a CO-oximeter sensor on the tongue. Inspired oxygen fraction (FiO2) was increased from 21% to > 95% in increments of 5%. PaO2 and ORI were recorded and compared at different times. The relationship between ORI and PaO2 was investigated using a nonlinear function, the Hill equation, and a linear regression analysis was performed, as appropriate. RESULTS A total of 128 pairs of values were compared for all dogs. Applying the Hill equation to the relationship between ORI and PaO2 resulted in R2 = 0.80 (p < 0.001) with a Hill coefficient of 3.7. It was predicted that ORI ranged 0.1-0.9 as PaO2 ranged 127.0-417.9 mmHg and that in the more linear portion of the range, PaO2 of 127.0-289.9 mmHg ORI ranged 0.1-0.7. Linear regression analysis in the more linear portion showed a weak correlation (R2 = 0.29, p = 0.006). CONCLUSIONS AND CLINICAL RELEVANCE In the present study, the Hill equation predicted the relationship between PaO2 and ORI for PaO2 ranging 127.0-417.9 mmHg in anesthetized dogs. However, in the linear portion of the PaO2, the coefficient of determination was low, indicating that ORI is not a surrogate for PaO2.
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Affiliation(s)
- Tamaki Watanabe
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan.
| | - Nobuo Kanno
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Shuji Suzuki
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Takuya Yogo
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Yasuji Harada
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Yasusi Hara
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
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Fadel ME, Shangab MO, Walley HE, Al Taher H, Lobo FA. Oxygen Reserve Index and Arterial Partial Pressure of Oxygen: Relationship in Open Heart Surgery. J Clin Monit Comput 2023; 37:1435-1440. [PMID: 37024751 DOI: 10.1007/s10877-023-01001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Mild to moderate hyperoxia is potentially beneficial to patients undergoing open heart surgery. Oxygen Reserve Index (ORI) is a novel parameter that correlates to arterial oxygen tension (PaO2) in the hyperoxic range. This prospective study aimed to assess whether the relationship between ORI and PaO2 remains intact in the setting of open-heart surgery. METHODS This study included patients undergoing valve, aortic arch and coronary artery bypass grafting (CABG) surgeries, on and off pump, between September 1st 2019 and August 31st 2021. Enrolled patients had arterial blood gas samples collected and analyzed after induction of anesthesia and increases in FiO2 in steps of 0.08 with ORI being recorded at the time of sample collection for cross reference and analysis. RESULTS ORI values showed a statistically significant correlation with PaO2 values in the 100-200 mmHg range (r = 0.8193, p < 0.001). Additionally, there was a significant correlation between ORI and SpO2 values in the range of 95% and 100% (r = 0.529, p < 0.05). CONCLUSIONS The preserved relationship between ORI and PaO2 in the mild and moderate hyperoxic range can allow more precise titration of oxygen therapy to guide therapy targeting normoxia, mildly and moderately hyperoxia. Additionally, it could have a potential use as an early warning system for impeding hypoxia.
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Affiliation(s)
| | - Majid O Shangab
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | | | | | - Francisco A Lobo
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Lee S, Kim M, Kang HY, Choi JH, Kim MK, You AH. Comparison of oxygen reserve index according to the remimazolam or dexmedetomidine for intraoperative sedation under regional anesthesia-A single-blind randomized controlled trial. Front Med (Lausanne) 2023; 10:1288243. [PMID: 38034542 PMCID: PMC10684752 DOI: 10.3389/fmed.2023.1288243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction We aimed to evaluate the difference in intraoperative oxygen reserve index (ORi) between the sedatives remimazolam (RMMZ) and dexmedetomidine (DEX). Methods Seventy-eight adult patients scheduled for sedation under regional anesthesia were randomly assigned to either the DEX (n = 39) or RMMZ (n = 39) group. The primary outcome was the difference in perioperative ORi between the groups. The secondary outcomes included respiratory depression, hypo- or hypertension, heart rate (HR), blood pressure, respiratory rate and postoperative outcomes. Additionally, the number of patients who experienced a decrease in intraoperative ORi to < 50% and the associated factors were analyzed. Results The ORi was significantly higher in the RMMZ group at 15 min after sedation maintenance. There were no significant differences in respiratory depression between the two groups. The intraoperative HR was significantly higher in the RMMZ group after the induction of sedation, 15 min after sedation maintenance, and at the end of surgery. No other results were significantly different between the two groups. The incidence of a decrease in intraoperative ORi to < 50% was significantly higher in the DEX group. Factors associated with a decrease in the intraoperative ORi to < 50% were diabetes mellitus, low baseline peripheral oxygen saturation (SpO2), and DEX use. In the receiver operating characteristic curve analysis for a decrease in the intraoperative ORi to < 50%, the cutoff baseline SpO2 was 97%. Conclusion RMMZ is recommended as a sedative for patients with a low baseline SpO2 and intraoperative bradycardia. Further studies should be conducted to establish the criteria for a significant ORi reduction.
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Wittenmeier E, Schmidtmann I, Heese P, Müller P, Didion N, Kriege M, Komorek Y, Pirlich N. Early warning for SpO 2 decrease by the oxygen reserve index in neonates and small infants. Paediatr Anaesth 2023; 33:923-929. [PMID: 37551627 DOI: 10.1111/pan.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Continuously assessing the oxygenation levels of patients to detect and prevent hypoxemia can be advantageous for safe anesthesia, especially in neonates and small infants. The oxygen reserve index (ORI) is a new parameter that can assess oxygenation through a relationship with arterial oxygen partial pressure (PaO2 ). The aim of this study was to examine whether the ORI provides a clinically relevant warning time for an impending SpO2 (pulse oximetry hemoglobin saturation) reduction in neonates and small infants. METHODS ORI and SpO2 were measured continuously in infants aged <2 years during general anesthesia. The warning time and sensitivity of different ORI alarms for detecting impending SpO2 decrease were calculated. Subsequently, the agreement of the ORI and PaO2 with blood gas analyses was assessed. RESULTS The ORI of 100 small infants and neonates with a median age of 9 months (min-max, 0-21 months) and weight of 8.35 kg (min-max, 2-13 kg) were measured. For the ORI/PaO2 correlation, 54 blood gas analyses were performed. The warning time and sensitivity of the preset ORI alarm during the entire duration of anesthesia were 84 s (25th-75th percentile, 56-102 s) and 55% (95% CI 52%-58%), and those during anesthesia induction were 63 s (40-82 s) and 56% (44%-68%), respectively. The positive predictive value of the preset ORI alarm were 18% (95% CI 17%-20%; entire duration of anesthesia) and 27% (95% CI 21%-35%; during anesthesia induction). The agreement of PaO2 intervals with the ORI intervals was poor, with a kappa of 0.00 (95% CI = [-0.18; 0.18]). The weight (p = .0129) and height (p = .0376) of the infants and neonates were correlated to the correct classification of the PaO2 interval with the ORI interval. CONCLUSIONS The ORI provided an early warning time for detecting an impending SpO2 decrease in small infants and neonates in the defined interval in this study. However, the sensitivity of ORI to forewarn a SpO2 decrease and the agreement of the ORI with PaO2 intervals in this real-life scenario were too poor to recommend the ORI as a useful early warning indicator for this age group.
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Affiliation(s)
- Eva Wittenmeier
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Irene Schmidtmann
- Biostatistician, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Pascal Heese
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Pascal Müller
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Nicole Didion
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Marc Kriege
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Yannick Komorek
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Nina Pirlich
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Bellini L, De Benedictis GM. Oxygen Reserve Index as a Tool to Monitor Four Techniques of Oxygen Supplementation at Different Flow Rates in Dogs Sedated with Dexmedetomidine and an Opioid. Animals (Basel) 2023; 13:3077. [PMID: 37835683 PMCID: PMC10572064 DOI: 10.3390/ani13193077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Respiratory dysfunction often decreases arterial oxygen content. Four common oxygen delivery techniques-flow-by, nasal prongs, a tight-vented mask, and a tight mask connected to a Venturi valve-were evaluated for their effectiveness in increasing the oxygen reserve index (ORi), a dimensionless index of oxygen content that provides additional information compared to traditional pulse oximetry (SpO2) during hyperoxia (PaO2 100-200 mmHg), and that ranges from 0 to 1. Thirty-two dogs sedated with dexmedetomidine and an opioid were evenly divided into four groups based on the technique for oxygen administration. Each dog received oxygen at 1, 2, and 3 L/min by a single technique, and the amount of inhaled oxygen (FiO2) was measured at the level of the cervical trachea. At each flow rate, ORi and SpO2 were recorded. The flow-by method minimally increased the FiO2, and ORi reached its highest value only in 3 out of 8 dogs at the maximum flow rate. Other methods exhibited direct correlations between the oxygen flow rate and ORi (p < 0.001). These methods effectively increased FiO2 and ORi, with over half of the values exceeding 40% and 0.4, respectively. The tight-vented mask showed variable increases in FiO2, ranging between 22 and 90%. Despite method-dependent variations, all devices increased SpO2 > 98% as the FiO2 increased (p = 0.002). In conclusion, nasal prongs and the mask connected to the Venturi valve showed the highest correlation between the oxygen flow rate and the ORi. These results suggest that using these two techniques in conjunction with ORI can help in optimizing oxygen therapy.
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Affiliation(s)
- Luca Bellini
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell’Università 16, 35028 Legnaro, Italy;
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Maeda M, Yoshikawa Y, Oura S, Takahashi K, Ohno S, Hirata N, Yamakage M. Apnea management during WATCHMAN device deployment with apneic oxygenation: A case report of three cases. Ann Card Anaesth 2023; 26:458-460. [PMID: 37861586 PMCID: PMC10691579 DOI: 10.4103/aca.aca_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 10/21/2023] Open
Abstract
WATCHMAN is a percutaneous left atrial appendage closure device that is implanted in patients who are unsuitable for anticoagulation therapy for atrial fibrillation. During WATCHMAN implantation, inducing apnea in the patient is preferable to allow stable deployment. We present three cases in which apneic oxygenation was employed to maintain oxygenation during apnea, and oxygen reserve index (ORiTM) was measured to evaluate its safety and efficacy. Oxygen was administered continuously via the endotracheal tube during apnea. During all four apneic events in three patients (mean duration of 356 seconds), the ORi values maintained above 0.24, which is generally considered the threshold of partial pressure of arterial oxygen (PaO2) > 100 mmHg. Transcutaneous oxygen saturation and PaO2 remained above 99% and 300 mmHg, respectively. There were no respiratory or circulatory complications during or after the surgery.
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Affiliation(s)
- Makishi Maeda
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yusuke Yoshikawa
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shunsuke Oura
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kanako Takahashi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sho Ohno
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Hirata
- Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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15
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Park S, Kim SY, Kim MS, Park WK, Byon HJ, Kim HJ. Comparison of preoxygenation efficiency measured by the oxygen reserve index between high-flow nasal oxygenation and facemask ventilation: a randomised controlled trial. BMC Anesthesiol 2023; 23:159. [PMID: 37161369 PMCID: PMC10169184 DOI: 10.1186/s12871-023-02126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND High-flow nasal oxygenation and the oxygen reserve index (ORI), which is a non-invasive and innovative modality that reflects the arterial oxygen content, are used in general anaesthesia. This study compares the preoxygenation efficiency (measured by the ORI) of high-flow nasal oxygenation and facemask ventilation during the induction process. METHODS This single-centre, two-group, randomised controlled trial included 197 patients aged ≥ 20 years who underwent orotracheal intubation for general anaesthesia for elective surgery. The patients were randomly allocated to receive preoxygenation via facemask ventilation or high-flow nasal oxygenation. The ORI was measured and compared between both groups. RESULTS The ORI increased during preoxygenation in all patients. At 1 min of preoxygenation, the ORI was significantly higher in the high-flow nasal oxygenation group (0.34 ± 0.33) than in the facemask ventilation group (0.21 ± 0.28; P = 0.003). The highest ORI was not significantly different between the two groups (0.68 ± 0.25 in the high-flow nasal oxygenation group vs. 0.70 ± 0.28 in the facemask ventilation group; P = 0.505). CONCLUSIONS High-flow nasal oxygenation results in an oxygenation status similar to that provided by facemask ventilation during the induction process of general anaesthesia; therefore, high-flow nasal oxygenation is a feasible preoxygenation method. TRIAL REGISTRATION Clinicaltrials.gov (NCT04291339).
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Affiliation(s)
- Sujung Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Di Pumpo F, Meloni G, Paganini M, Cialoni D, Garetto G, Cipriano A, Giacon TA, Martani L, Camporesi E, Bosco G. Comparison between Arterial Blood Gases and Oxygen Reserve Index™ in a SCUBA Diver: A Case Report. Healthcare (Basel) 2023; 11:healthcare11081102. [PMID: 37107936 PMCID: PMC10138174 DOI: 10.3390/healthcare11081102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Hypoxia and hyperoxia are both worrisome issues potentially affecting SCUBA divers, but validated methods to monitor these two conditions underwater are still lacking. In this experiment, a volunteer SCUBA diver was equipped with a pulse oximeter to detect peripheral oxygen saturation (SpO2) and a device to monitor the oxygen reserve index (ORi™). ORi™ values were compared with arterial blood oxygen saturation (SaO2) and the partial pressure of oxygen (PaO2) obtained from the cannulated right radial artery at three steps: at rest out of water; at -15 m underwater after pedaling on a submerged bike; after resurfacing. SpO2 and ORi™ mirrored the changes in SaO2 and PaO2, confirming the expected hyperoxia at depth. To confirm the potential usefulness of an integrated SpO2 and ORi™ device, further studies are needed on a broader sample with different underwater conditions and diving techniques.
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Affiliation(s)
- Fabio Di Pumpo
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
- ComSubIn, Italian Navy, 19025 Varignano-Le Grazie, Italy
| | | | - Matteo Paganini
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Danilo Cialoni
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | | | - Alessandro Cipriano
- Emergency Medicine Unit and Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria of Pisa, 56126 Pisa, Italy
| | | | - Luca Martani
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Enrico Camporesi
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Gerardo Bosco
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
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Yajima R, Ishida Y, Kobayashi T, Uchino H. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-End Anastomosis for a Malignant Thyroid Tumor With Tracheal Invasion. Cureus 2023; 15:e35728. [PMID: 37016655 PMCID: PMC10066925 DOI: 10.7759/cureus.35728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
When tracheal invasion of cancerous diseases such as thyroid cancer occurs, tracheal resection followed by end-to-end anastomosis is a treatment of choice. Anesthetic management of the patient during this procedure may pose challenges, such as maintaining ventilation during tracheal dissection, resection of the tracheal invasion, and tracheal end-to-end anastomosis. Here, we have presented a case of a woman in her 50s. Computed tomography of the head and neck displayed a 31-mm mass in the medial lobe of the thyroid gland, and irregularities in the trachea and right tracheoesophageal groove. We decided to perform total thyroidectomy followed by tracheal resection and end-to-end tracheal anastomosis, as a radical treatment. Anesthetic management was successfully performed without a decrease in the peripheral blood oxygen saturation level, due to managing oxygenation by using the oxygen reserve index (ORITM) monitoring during the tracheostomy, tracheal infiltration division resection, and tracheal end-to-end suturing. This case was a unique situation requiring two intraoperative tube exchanges, but the ORI monitoring of oxygenation enabled safe anesthetic management.
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18
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[Oxygen reserve index: a new parameter for oxygen therapy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1275-1280. [PMID: 36398556 PMCID: PMC9678064 DOI: 10.7499/j.issn.1008-8830.2206112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oxygen reserve index (ORI) is a novel dimensionless index used for noninvasive, real-time, and continuous monitoring of oxygenation, and ORI value ranges from 0 to 1, which reflects the range of 100-200 mmHg for arterial partial pressure of oxygen. ORI combined with pulse oximetry may help to accurately adjust the concentration of inspired oxygen and prevent hyperoxemia and hypoxemia. ORI is suitable for various clinical situations, and the medical staff should master this novel parameter and use it properly to assess the oxygenation of patients. In addition, several limitations of ORI should be noticed during clinical application.
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19
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Ramos M, Tau Anzoategui S. Preoxygenation: from hardcore physiology to the operating room. J Anesth 2022; 36:770-781. [PMID: 36136165 DOI: 10.1007/s00540-022-03105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
If we define the human body by the mass of the elements that compose it, we could say that we are oxygen and other elements. Oxygen, in addition to being fundamental in our composition, is an element that we constantly need to support cellular respiration and, therefore, life. Interestingly, despite its importance, humans have not developed mechanisms that allow us to store it and, therefore, we are unable to sustain life if we are deprived of ventilation, even for brief periods. Accordingly, the ability to induce the cessation of ventilation in a patient must be accompanied by different technical and non-technical skills that allow the patient's safety to be maintained in this highly vulnerable state. Through the use of basic mathematical tools and comparative physiology, we hereby propose to review the physiological foundations of preoxygenation to understand the reasons behind the clinical recommendations in this field.
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Affiliation(s)
- Matias Ramos
- Department of Anesthesiology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina.
| | - Santiago Tau Anzoategui
- Department of Anesthesiology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
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20
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Matsuba S, Sawai M, Higashitani S, Sawasaki F, Kida H, Takahashi K. Anesthetic management in a patient with severe tracheal stenosis by monitoring oxygen reserve index. JA Clin Rep 2022; 8:73. [PMID: 36107332 PMCID: PMC9477987 DOI: 10.1186/s40981-022-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background General anesthesia for tracheal stenting is challenging because of difficult ventilation and accompanying hypoxia. We report the use of oxygen reserve index (ORi™) during tracheal stenting. Case presentation Cauterization of an intratracheal tumor and tracheal stenting was scheduled in a patient. ORi decreased from 0.3 to 0.2 after starting cauterization using a flexible bronchoscope through a tracheal tube with 28% oxygen, while SpO2 was maintained at 100%. ORi further decreased to 0, followed by a decrease of SpO2 < 90%, and surgery was interrupted. SpO2 was increased shortly after increasing FiO2 to 1.0, but ORi remained 0 when surgery was resumed; it was increased after completion of cauterization. Both ORi and SpO2 were maintained above 0.4 and 98%, respectively, during tracheal stenting through a rigid bronchoscope under intrapulmonary percussive ventilation. Conclusion ORi was useful for predicting a decrease of SpO2 under general anesthesia for tracheal stenting.
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Kim EH, Ji SH, Lee JH, Kim JT, Jang YE, Kwon SK, Kim HS. Use of high-flow nasal oxygen in spontaneously breathing pediatric patients undergoing tubeless airway surgery: A prospective observational study. Medicine (Baltimore) 2022; 101:e29520. [PMID: 35801795 PMCID: PMC9259177 DOI: 10.1097/md.0000000000029520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The use of high-flow nasal oxygen is gaining popularity in apneic and spontaneously breathing adult patients during anesthesia. This prospective observational study evaluated the effect of high-flow nasal oxygen in maintaining adequate oxygenation and ventilation in spontaneously breathing pediatric patients with dynamic airway obstruction, undergoing tubeless airway surgery. Oxygenation was provided via an age-appropriate, high-flow nasal cannula at a flow rate of 2 L kg-1 min-1. Propofol and remifentanil were used to maintain anesthesia while preserving spontaneous respiration. We sought to determine the incidence and risk factors of rescue ventilation. Rescue ventilation with a face mask was performed when the pulse oximetry oxygen saturation was <90% or transcutaneous carbon dioxide was >80 mm Hg. In total, 27 patients were included in the final analysis. Median (interquartile range) of pulse oximetry and transcutaneous carbon dioxide were 100% (99%-100%) and 58.4 mm Hg (51.4-70.3 mm Hg), respectively. Altogether, 9 (33.3%) patients needed rescue ventilation during anesthesia. Of these, 7 patients (25.9%) developed oxygen desaturation (<90%) and 2 patients (7.4%) developed hypercarbia. Patients who required rescue ventilation were significantly younger (8.2 vs 28.8 months, P = .02) and required a longer anesthesia time (55.7 vs 41.0 minutes, P = .04) than those who did not. In conclusion, High-flow nasal oxygen is an alternative technique to maintain oxygenation in children undergoing airway surgeries. However, younger age and longer anesthesia time are significant risk factors leading to the requirement of rescue ventilation in these patients. Further studies with large sample size are required for clinical application of these techniques.
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Affiliation(s)
- Eun-Hee Kim
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- * Correspondence: Hee-Soo Kim, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (e-mail: )
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Yang M, Kim JA, Ahn HJ, Choi YS, Park M, Jeong H, Kim K, Lee NY. Continuous Titration of Inspired Oxygen Using Oxygen Reserve Index to Decrease Oxygen Exposure During One-Lung Ventilation: A Randomized Controlled Trial. Anesth Analg 2022; 135:91-99. [PMID: 35245224 DOI: 10.1213/ane.0000000000005967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A high fraction of inspired oxygen (Fio2) is administered during one-lung ventilation (OLV). However, a high Fio2 is not physiologic and may lead to various complications. We hypothesized that continuous titration of Fio2 using the oxygen reserve index (ORI) reduces oxygen exposure compared to conventional management during OLV. METHODS In this randomized, double-blinded trial, patients undergoing thoracic surgery were assigned to an ORI (n = 64) or a control group (n = 60). In the ORI group, ORI was continuously displayed using multiwavelength pulse co-oximetry (Masimo) between 0 and 1 (0, no reserve; 1, maximum reserve), and Fio2 was titrated for a target ORI of 0.21 at 5-minute intervals during OLV. In the control group, Fio2 was adjusted using arterial blood gas analysis measured at 15 minutes after OLV initiation. The primary end point was the time-weighted average Fio2 during OLV. RESULTS Overall, time-weighted average Fio2 did not differ between the groups (control versus ORI: median [interquartile range], 0.87 [0.73-1.00] vs 0.82 [0.68-0.93]; P = .09). However, in a subgroup analysis, the ORI group reduced time-weighted average Fio2 after pulmonary vascular ligation compared to the control group (control versus ORI: median [interquartile range], 0.75 [0.70-1.00] vs 0.72 [0.59-0.89]; P = .0261). The incidence of intraoperative hypoxia (arterial oxygen saturation [Spo2] <94%; control versus ORI: 32% [19/60; 95% confidence interval (CI), 20-45] vs 19% [12/64; 95% CI, 10-31]; P = .09), and postoperative complications within the first 7 days did not differ between the groups. CONCLUSIONS ORI-guided continuous Fio2 titration does not reduce overall oxygen exposure during OLV.
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Affiliation(s)
- Mikyung Yang
- From the Departments of Anesthesiology and Pain Medicine
| | - Jie Ae Kim
- From the Departments of Anesthesiology and Pain Medicine
| | - Hyun Joo Ahn
- From the Departments of Anesthesiology and Pain Medicine
| | - Young Soo Choi
- Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - MiHye Park
- From the Departments of Anesthesiology and Pain Medicine
| | - Heejoon Jeong
- From the Departments of Anesthesiology and Pain Medicine
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Dankook University, Cheon-an, South Korea
| | - Nam Young Lee
- From the Departments of Anesthesiology and Pain Medicine
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de Courson H, Julien-Laferrière T, Georges D, Boyer P, Verchère E, Biais M. The ability of Oxygen Reserve Index® to detect hyperoxia in critically ill patients. Ann Intensive Care 2022; 12:40. [PMID: 35576087 PMCID: PMC9110610 DOI: 10.1186/s13613-022-01012-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hyperoxia is associated with increased morbidity and mortality in the intensive care unit. Classical noninvasive measurements of oxygen saturation with pulse oximeters are unable to detect hyperoxia. The Oxygen Reserve Index (ORI) is a continuous noninvasive parameter provided by a multi-wave pulse oximeter that can detect hyperoxia. Primary objective was to evaluate the diagnostic accuracy of the ORI for detecting arterial oxygen tension (PaO2) > 100 mmHg in neurocritical care patients. Secondary objectives were to test the ability of ORI to detect PaO2 > 120 mmHg and the ability of pulse oximetry (SpO2) to detect PaO2 > 100 mmHg and PaO2 > 120 mmHg. Methods In this single-center study, we collected ORI and arterial blood samples every 6 h for 3 consecutive days. Diagnostic performance was estimated using the area under the receiver operating characteristic curve (AUROC). Results There were 696 simultaneous measurements of ORI and PaO2 in 62 patients. Considering the repeated measurements, the correlation between ORI and PaO2 was r = 0.13. The area under the receiver operating characteristic curve (AUROC), obtained to test the ability of ORI to detect PaO2 > 100 mmHg, was 0.567 (95% confidence interval = 0.566–0.569) with a sensitivity of 0.233 (95%CI = 0.230–0.235) and a specificity of 0.909 (95%CI = 0.907–0.910). The AUROC value obtained to test the ability of SpO2 to detect a PaO2 > 100 mmHg was 0.771 (95%CI = 0.770–0.773) with a sensitivity of 0.715 (95%CI = 0.712–0.718) and a specificity of 0.700 (95%CI = 0.697–0.703). The diagnostic performance of ORI and SpO2 for detecting PaO2 > 120 mmHg was AUROC = 0.584 (95%CI = 0.582–0.586) and 0.764 (95%CI = 0.762–0.766), respectively. The AUROC obtained for SpO2 was significantly higher than that for ORI (p < 0.01). Diagnostic performance was not affected by sedation, norepinephrine infusion, arterial partial pressure of carbon dioxide, hemoglobin level and perfusion index. Conclusion In a specific population of brain-injured patients hospitalized in a neurointensive care unit, our results suggest that the ability of ORI to diagnose hyperoxia is relatively low and that SpO2 provides better detection. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01012-w.
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Affiliation(s)
- Hugues de Courson
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, UMR 1219, Bordeaux Population Health Research Center, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Delphine Georges
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Philippe Boyer
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Eric Verchère
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France
| | - Matthieu Biais
- Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Bordeaux, France. .,Biology of Cardiovascular Diseases, Institut National de la Santé et de la Recherche Médicale, U1034, Pessac, France.
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Abstract
Ensuring and maintaining adequate tissue oxygenation at the microcirculatory level might be considered the holy grail of optimal hemodynamic patient management. However, in clinical practice we usually focus on macro-hemodynamic variables such as blood pressure, heart rate, and sometimes cardiac output. Other macro-hemodynamic variables like pulse pressure or stroke volume variation are additionally used as markers of fluid responsiveness. In recent years, an increasing number of technological devices assessing tissue oxygenation or microcirculatory blood flow have been developed and validated, and some of them have already been incorporated into clinical practice. In this review, we will summarize recent research findings on this topic as published in the last 2 years in the Journal of Clinical Monitoring and Computing (JCMC). While some techniques are already currently used as routine monitoring (e.g. cerebral oxygenation using near-infrared spectroscopy (NIRS)), others still have to find their way into clinical practice. Therefore, further research is needed, particularly regarding outcome measures and cost-effectiveness, since introducing new technology is always expensive and should be balanced by downstream savings. The JCMC is glad to provide a platform for such research.
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Gook J, Kwon JH, Kim K, Choi JW, Chung IS, Lee J. Awake craniotomy using a high-flow nasal cannula with oxygen reserve index monitoring - A report of two cases. Anesth Pain Med (Seoul) 2022; 16:338-343. [PMID: 35139614 PMCID: PMC8828626 DOI: 10.17085/apm.21022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Awake craniotomy is a well-tolerated procedure for the resection of brain tumors residing within or close to the eloquent cortical areas. Monitored anesthesia care (MAC) is a dominant anesthetic approach for awake craniotomy; however, it is associated with inherent challenges such as desaturation and hypercapnia, which may lead to various complications. The prevention of respiratory insufficiency is important for successful awake craniotomy. As measures to avoid respiratory depression, the use of high-flow nasal cannula (HFNC) can improve patient oxygenation and monitor the monitoring the oxygen reserve index (ORi) can detect hypoxia earlier. CASE We report two cases of awake craniotomy with MAC using HFNC and ORi. We adjusted the fraction of inspired oxygen of the HFNC according to the ORi level. The patient underwent successful awake craniotomy without a desaturation event or additional airway intervention. CONCLUSIONS Combined HFNC and ORi monitoring may provide adequate oxygen reserves in patients undergoing awake craniotomy.
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Affiliation(s)
- Joonhee Gook
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, Dankook University Dental Hospital, Cheonan, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Soo Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeonjin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cheng HW, Yeh CY, Chang MY, Ting CK, Chang PL. How early warning with the Oxygen Reserve Index (ORi™) can improve the detection of desaturation during induction of general anesthesia? J Clin Monit Comput 2021; 36:1379-1385. [PMID: 34953137 DOI: 10.1007/s10877-021-00776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022]
Abstract
The Oxygen Reserve Index (ORi™) is a dimensionless parameter with a value between 0 and 1. It is related to the real-time oxygenation status in the moderate hyperoxic range. The purpose of this study is to investigate the added warning time provided by different ORi alarm triggers and the continuous trends of ORi, SpO2, and PaO2. We enrolled 25 patients who were scheduled for elective surgery under general anesthesia with planned arterial catheterization before induction. The participants received standardized preoxygenation, induction, and intubation. The patients remained apneic and ventilation was resumed when the SpO2 fell below 90%. The ORi and SpO2 were recorded every ten seconds and arterial blood was sampled every minute, from preoxygenation to resumed ventilation. Alarm triggers set to the ORi peak and the ORi 0.55 values provided 300 and 145 s of significant added warning time compared to SpO2 (p < 0.0001). The coefficient of determination was 0.56 between the ORi and the PaO2 ≤ 240 mmHg and showed a positive correlation. The ORi enables the clinicians to monitor the patients' oxygen status during induction of general anesthesia and can improve the detection of impending desaturation. However, further studies are needed to assess its clinical potential in the high hyperoxic range.The protocol was retrospectively registered at ClinicalTrials.gov on July 21, 2021 (NCT04976504).
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Affiliation(s)
- Hung-Wei Cheng
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC.,Department of Anesthesiology, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC.,Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC
| | - Chia-Yi Yeh
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC
| | - Man-Yun Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, 112, Taiwan, ROC.,Department of Anesthesiology, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC
| | - Po-Lun Chang
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, ROC.
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Saracoglu A, Zengin SU, Ozturk N, Niftaliyev S, Harman F, Aykac Z. The outcomes of using high oxygen concentration in pediatric patients. J Clin Monit Comput 2021; 36:1341-1346. [PMID: 34705168 DOI: 10.1007/s10877-021-00765-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
Oxygen reserve index, available as part of Masimo Rainbow SET pulse oximetry, is a noninvasive and continuous variable intended to provide insight into a patient's oxygen status in the moderate hyperoxic range (PaO2 > 100 and ≤ 200 mm Hg), defined as a patient's oxygen "reserve". When used in conjunction with pulse oximetry, ORi extends the knowledge on a patient's oxygen status providing clinically important information helping to prevent hyperoxemia and hypoxemia. There are limited data on patients undergoing craniosynostosis surgery. Our primary goal was to evaluate the effects of different concentrations of inspiratory oxygen (FiO2) on patient oxygenation status by monitoring ORi. Thirty patients scheduled for craniosynostosis were included in this observational cohort study. Patients were randomized into two equal groups: Group 1 received a fraction of inspired oxygen of 0.8 and group 2 received a FiO2 of 0.6 during induction of anaesthesia. In addition to standard haemodynamic variables with ORi were recorded at baseline 1 min, 5 min, 60 min, and 120 min after intubation. Postoperative complications, length of stay in the intensive care unit and hospital were recorded. In total, 14 patients were evaluated in each group. Gender, age, BMI, ASA scores were similar between groups (p > 0.05). In Group 1, ORi values were significantly higher when compared to group 2 at baseline (0.86 ± 0.21 vs 0.45 ± 0.32, p = 0.001), one minute (0.61 ± 0.24 vs 0.27 ± 0.21, p = 0.001), and 5 min (0.34 ± 0.31 vs 0.10 ± 0.13, p = 0.033). High inspired oxygen concentration during induction of anesthesia in pediatric patients is associated with higher levels of ORi. Therefore, ORi may provide the means to safely reduce the inspired oxygen fraction during inhalational induction in paediatric patients.
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Affiliation(s)
- Ayten Saracoglu
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey.
| | - Seniyye Ulgen Zengin
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey
| | - Nilufer Ozturk
- Department of Pediatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Seymur Niftaliyev
- Department of Neurosurgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Harman
- Department of Neurosurgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Zuhal Aykac
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey
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Min SH, Yoon H, Huh G, Kwon SK, Seo JH, Cho YJ. Efficacy of high-flow nasal oxygenation compared with tracheal intubation for oxygenation during laryngeal microsurgery: a randomised non-inferiority study. Br J Anaesth 2021; 128:207-213. [PMID: 34688473 DOI: 10.1016/j.bja.2021.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Oxygenation via a high-flow nasal cannula (HFNC) can be an alternative to tracheal intubation during short apnoeic procedures. This randomised, non-inferiority study assessed the efficacy of HFNC compared with tracheal intubation in laryngeal microsurgery. METHODS Patients (≥20 yr old) undergoing laryngeal microsurgery under general anaesthesia and neuromuscular blockade were randomised to either the HFNC or tracheal intubation groups. The primary endpoint was lowest pulse oxygen saturation (SpO2) during the first 30 min of surgery. Secondary endpoints included incidence of desaturation (SpO2 <95%), hypercarbia (transcutaneous carbon dioxide [CO2] ≥8.7 kPa), and rescue intervention. RESULTS Amongst 130 patients randomised, 118 were included in the analysis. The lowest SpO2 was 100 (98-100)% in the HFNC group (n=56) and 100 (100-100)% in the tracheal intubation group (n=62), with a mean difference of -1.4% (95% confidence interval: -2.4% and -0.3%), failing to confirm non-inferiority with a non-inferiority margin of 2%. The peak transcutaneous CO2 and end-tidal CO2 at the end of surgery were higher in the HFNC group compared with the tracheal intubation group. Incidences of desaturation, hypercarbia, and rescue intervention were more frequent in patients receiving HFNC compared with tracheal intubation. CONCLUSIONS HFNC oxygenation was not non-inferior to tracheal intubation for maintaining oxygen saturation during laryngeal microsurgery. Considering more frequent desaturation, hypercarbia, and requirement for rescue intervention compared with tracheal intubation, HFNC should be used with cautious monitoring even for short duration airway surgery. CLINICAL TRIAL REGISTRATION NCT03629353.
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Affiliation(s)
- Se-Hee Min
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Heechul Yoon
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong K Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hwa Seo
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn J Cho
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Abstract
Supplemental Digital Content is available in the text. Pao2 is the gold standard to assess acute hypoxic respiratory failure, but it is only routinely available by intermittent spot checks, precluding any automatic continuous analysis for bedside tools.
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30
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Ishida Y, Okada T, Kobayashi T, Uchino H. ORi™: a new indicator of oxygenation. J Anesth 2021; 35:734-740. [PMID: 33900455 PMCID: PMC8072303 DOI: 10.1007/s00540-021-02938-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
In the perioperative period, hypoxemia and hyperoxia are crucial factors that require attention, because they greatly affect patient prognoses. The pulse oximeter has been the only noninvasive monitor that can be used as a reference of oxygenation in current anesthetic management; however, in recent years, a new monitoring method that uses the oxygen reserve index (ORi™) has been developed by Masimo Corp. ORi is an index that reflects the state of moderate hyperoxia (partial pressure of arterial oxygen [PaO2] between 100 and 200 mmHg) using a non-unit scale between 0.00 and 1.00. ORi monitoring performed together with percutaneous oxygen saturation (SpO2) measurements may become an important technique in the field of anesthetic management, for measuring oxygenation reserve capacity. By measuring ORi, it is possible to predict hypoxemia and to detect hyperoxia at an early stage. In this review, we summarize the method of ORi, cautions for its use, and suitable cases for its use. In the near future, the monitoring of oxygen concentrations using ORi may become increasingly common for the management of respiratory function before, after, and during surgery.
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Affiliation(s)
- Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Toshio Okada
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Takayuki Kobayashi
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Hiroyuki Uchino
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
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Matsui Y, Takazawa T, Takemae A, Murooka Y, Kanamoto M, Saito S. Investigation of the optimal method of oxygen administration with simultaneous use of a surgical mask: a randomized control study. J Anesth 2021; 36:26-31. [PMID: 34491428 PMCID: PMC8422829 DOI: 10.1007/s00540-021-02998-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
Purpose From the perspective of infection prevention during the Coronavirus disease 2019 (COVID-19) pandemic, a recommendation was made to use surgical masks after extubation in patients in the operating room. For compliance with this recommendation, anesthesiologists need to administer oxygen to the patient with an oxygen mask over the surgical mask. However, no studies have investigated whether this method allows good maintenance of oxygenation in patients. This study aimed to investigate which method of oxygen administration lends itself best to use with a surgical mask in terms of oxygenation. Method We administered oxygen to the study subjects using all the following three methods in random order: an oxygen mask over or under a surgical mask and a nasal cannula under the surgical mask. Oxygenation was assessed using the oxygen reserve index (ORi) and end-tidal oxygen concentration (EtO2). Result This study included 24 healthy volunteers. ORi values with administration of oxygen were higher in the order of a nasal cannula under the surgical mask, an oxygen mask under the surgical mask, and an oxygen mask over the surgical mask, with median values of 0.50, 0.48, and 0.43, respectively, and statistically significant differences between all groups (P < 0.001). EtO2 values were in the same order as ORi, with median values of 33.0%, 31.0%, and 25%, respectively, and statistically significant differences between all groups (P < 0.001). Conclusion Wearing a surgical mask over the nasal cannula during oxygen administration is beneficial for oxygenation and might help prevent aerosol dispersal. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02998-6.
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Affiliation(s)
- Yusuke Matsui
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tomonori Takazawa
- Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Akihito Takemae
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukie Murooka
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masafumi Kanamoto
- Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Facilitation of delayed sequence intubation with oxygen reserve index monitoring in a child with esophageal perforation. Can J Anaesth 2021; 68:1826-1827. [PMID: 34426959 DOI: 10.1007/s12630-021-02092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022] Open
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Hille H, Le Thuaut A, Canet E, Lemarie J, Crosby L, Ottavy G, Garret C, Martin M, Seguin A, Lamouche-Wilquin P, Morin J, Zambon O, Miaihle AF, Reignier J, Lascarrou JB. Oxygen reserve index for non-invasive early hypoxemia detection during endotracheal intubation in intensive care: the prospective observational NESOI study. Ann Intensive Care 2021; 11:112. [PMID: 34406524 PMCID: PMC8374021 DOI: 10.1186/s13613-021-00903-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/06/2021] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate the ability of the oxygen reserve index (ORI) to predict the occurrence of mild hypoxemia (defined as SpO2 < 97%) during endotracheal intubation (ETI) of patients in the intensive care unit (ICU). Methods This observational single-centre study included patients without hypoxemia (defined as SpO2/FiO2 > 214) who required ETI in the ICU. Patients were followed during preoxygenation and ETI then until hospital discharge and/or day 28. We recorded cases of mild hypoxemia, moderate (SpO2 < 90%) and severe (SpO2 < 80%) hypoxemia, moderate arterial hypotension (systolic arterial pressure < 90 mmHg), oesophageal intubation, aspiration, cardiac arrest, and death. Results Between January 2019 and July 2020, 56 patients were included prospectively and 51 patients were analysed. Twenty patients had mild hypoxemia between the end of preoxygenation and the end of intubation; in 10 of these patients, the decrease in SpO2 below 97% was preceded by an ORI < 0.4, the median time difference being 81 s [interquartile range, 34–146]. By multivariable analysis, a higher ORI (by 0.1 increase) value during preoxygenation was associated with absence of hypoxemia (odds ratio, 0.76; 95% confidence interval, 0.61;0.95; P = 0.0141). Conclusion In non-hypoxemic patients, the 81-s [34–146] median time between the ORI decrease below 0.4 and the SpO2 decrease below 97% during apnoea may allow preventive action. A higher ORI value during preoxygenation was independently protective against hypoxemia. Whether these findings also apply to hypoxemic patients, and the clinical impact of a preoxygenation strategy based on ORI monitoring, remain to be evaluated prospectively. Trial Registration ClinicalTrial.gov, #NCT03600181. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00903-8.
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Affiliation(s)
- Hugo Hille
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Aurelie Le Thuaut
- Plateforme de Méthodologie Et Biostatistique, Direction de La Recherche de L'Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuel Canet
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jeremie Lemarie
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Laura Crosby
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Gregoire Ottavy
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Charlotte Garret
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Maelle Martin
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Amelie Seguin
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | - Jean Morin
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Olivier Zambon
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Arnaud-Felix Miaihle
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Reignier
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Baptiste Lascarrou
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,Paris Cardiovascular Research Centre, Université de Paris, INSERM, Paris, France. .,Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
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Cho YJ, Jung DE, Oh Y, Nam K, Lee HC, Jeon Y, Cho YD, Kim TK. Heart rate variability and oxygen reserve index during cardiorespiratory events in patients undergoing ophthalmic arterial chemotherapy: a prospective observational study. J Clin Monit Comput 2021; 36:557-567. [PMID: 33733371 DOI: 10.1007/s10877-021-00687-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
Unexpected cardiorespiratory compromise has been reported during ophthalmic arterial chemotherapy in pediatric patients with retinoblastoma. Although the underlying mechanisms remain unclear, autonomic responses are presumed to contribute to these events. We hypothesized that periprocedural heart rate variability would differ between patients with and without events. Between April 2018 and September 2019, 38 patients (age under 7 years) were included. Heart rate variability was analyzed using electrocardiogram, and oxygen reserve index was also monitored. Cardiorespiratory events were defined as > 30% changes in blood pressure or heart rate, > 20% changes in end-tidal carbon dioxide, > 40% changes in peak inspiratory pressure, or pulse oxygen saturation < 90% during ophthalmic artery catheterization. Heart rate variability and oxygen reserve index were compared between patients with and without cardiorespiratory events. Cardiorespiratory events occurred in 13/38 (34%) patients. During the events, end-tidal carbon dioxide was significantly lower (median difference [95% CI], - 2 [- 4 to - 1] mmHg, p = 0.006) and the maximum peak inspiratory pressure was higher (30 [25-37] vs. 15 [14-16] hPa, p < 0.001), compared to patients without events. Standard deviation of normal-to-normal R-R interval, total power, and very low-frequency power domain increased during selection of the ophthalmic artery in patients with events (all adjusted p < 0.0001), without predominancy of specific autonomic nervous alterations. Oxygen reserve index was significantly lower in patients with events than those without throughout the procedure (mean difference [95% CI], - 0.19 [- 0.32 to - 0.06], p = 0.005). Enhanced compensatory autonomic regulation without specific autonomic predominancy, and reduced oxygen reserve index was observed in patients with cardiorespiratory events than in patients without events.
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Affiliation(s)
- Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Dhong-Eun Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yoomin Oh
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.
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Fleming NW, Singh A, Lee L, Applegate RL. Oxygen Reserve Index: Utility as an Early Warning for Desaturation in High-Risk Surgical Patients. Anesth Analg 2021; 132:770-776. [PMID: 32815872 DOI: 10.1213/ane.0000000000005109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Perioperative pulse oximetry hemoglobin saturation (Spo2) measurement is associated with fewer desaturation and hypoxia episodes. However, the sigmoidal nature of oxygen-hemoglobin dissociation limits the accuracy of estimation of the partial pressure of oxygen (Pao2) >80 mm Hg and correspondingly limits the ability to identify when Pao2 >80 mm Hg but falling. We hypothesized that a proxy measurement for oxygen saturation (Oxygen Reserve Index [ORI]) derived from multiwavelength pulse oximetry may allow additional warning time before critical desaturation or hypoxia. To test our hypothesis, we used a Masimo multiwavelength pulse oximeter to compare ORI and Spo2 warning times during apnea in high-risk surgical patients undergoing cardiac surgery. METHODS This institutional review board-approved prospective study (NCT03021473) enrolled American Society of Anesthesiologists physical status III or IV patients scheduled for elective surgery with planned preinduction arterial catheter placement. In addition to standard monitors, an ORI sensor was placed and patients were monitored with a pulse oximeter displaying the ORI, a nondimensional parameter that ranges from 0 to 1. Patients were then preoxygenated until ORI plateaued. Following induction of anesthesia, mask ventilation with 100% oxygen was performed until neuromuscular blockade was established. Endotracheal intubation was accomplished using videolaryngoscopy to confirm placement. The endotracheal tube was not connected to the breathing circuit, and patients were allowed to be apneic. Ventilation was resumed when Spo2 reached 94%. We defined ORI warning time as the time from when the ORI alarm registered (based on the absolute value and the rate of change) until the Spo2 decreased to 94%. We defined the Spo2 warning time as the time for Spo2 to decrease from 97% to 94%. The added warning time provided by ORI was defined as the difference between ORI warning time and Spo2 warning time. RESULTS Forty subjects were enrolled. Complete data for analysis were available from 37 patients. The ORI alarm registered before Spo2 decreasing to 97% in all patients. Median (interquartile range [IQR]) ORI warning time was 80.4 seconds (59.7-105.9 seconds). Median (IQR) Spo2 warning time was 29.0 seconds (20.5-41.0 seconds). The added warning time provided by ORI was 48.4 seconds (95% confidence interval [CI], 40.4-62.0 seconds; P < .0001). CONCLUSIONS In adult high-risk surgical patients, ORI provided clinically relevant added warning time of impending desaturation compared to Spo2. This additional time may allow modification of airway management, earlier calls for help, or assistance from other providers. The potential patient safety impact of such monitoring requires further study.
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Affiliation(s)
- Neal W Fleming
- From the Department of Anesthesiology and Pain Medicine, University of California Davis, Davis, California
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Hirata N, Nishimura M, Chaki T, Yoshikawa Y, Yamakage M. Comparison between oxygen reserve index and end-tidal oxygen concentration for estimation of oxygenation during pre-oxygenation via a tight-fitted face mask: A prospective observational study. Eur J Anaesthesiol 2021; 38:313-315. [PMID: 33538433 DOI: 10.1097/eja.0000000000001358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Naoyuki Hirata
- From the Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan (NH, MN, TC, YY, MY)
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Bellini L, Dzikiti BT, De Benedictis GM, Algarin Sepulveda FR, Maney JK. Oxygen reserve index as a noninvasive indicator of arterial partial pressure of oxygen in anaesthetized donkeys: a preliminary study. Vet Anaesth Analg 2021; 48:388-392. [PMID: 33632615 DOI: 10.1016/j.vaa.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/02/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the oxygen reserve index (ORI) as a noninvasive estimate of the PaO2 during moderate hyperoxaemia [100-200 mmHg (13.3-26.6 kPa)], and to determine ORI values identifying PaO2 > 100, > 150 (20.0 kPa) and > 200 mmHg in anaesthetized donkeys with an inspired fraction of oxygen (FiO2) > 0.95. STUDY DESIGN Prospective observational study. ANIMALS A group of 28 adult standard donkeys aged (mean ± standard deviation) 4 ± 2 years and weighing 135 ± 15 kg. METHODS Donkeys were sedated intramuscularly with xylazine and butorphanol; anaesthesia was induced with ketamine and diazepam and maintained with isoflurane in oxygen. An adhesive sensor probe was applied to the donkey's tongue and connected to a Masimo pulse co-oximeter to determine ORI values. An arterial catheter was inserted into an auricular artery. After ORI signal stabilization, the value was noted and PaO2 determined by blood gas analysis. The Pearson correlation coefficient was used to assess the relationship between ORI and PaO2 for oxygen tension < 200 mmHg (< 26.6 kPa). The Youden index was used to identify the value of ORI that detected PaO2 > 150 and 200 mmHg (20.0 and 26.6 kPa) with the highest sensitivity and specificity. RESULTS A total of 106 paired measurements were collected. A mild positive correlation was observed between ORI and PaO2 for values < 200 mmHg (26.6 kPa; r = 0.52). An ORI > 0.0, > 0.1 and > 0.3 indicated a PaO2 > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) with negative predictive values > 94%. CONCLUSIONS AND CLINICAL RELEVANCE ORI may provide a noninvasive indication of PaO2 > 100, > 150 and > 200 mmHg (13.3, 20.0 and 26.6 kPa) in anaesthetized donkeys with an FiO2 > 0.95, although it does not replace blood gas analysis for assessment of oxygenation.
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Affiliation(s)
- Luca Bellini
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy.
| | - Brighton T Dzikiti
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | | | - Felix R Algarin Sepulveda
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Jill K Maney
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
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Kumagai M, Kurihara H, Ishida K, Komatsu H, Suzuki K. The Oxygen Reserve Index as a determinant of the necessary amount of postoperative supplemental oxygen. Minerva Anestesiol 2020; 87:439-447. [PMID: 33319950 DOI: 10.23736/s0375-9393.20.14895-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although blood gas analysis (BGA) is important for supplemental oxygen titration, it is invasive, intermittent, costly, and burdensome for staff. We assessed whether the Oxygen Reserve Index (ORi™), a novel pulse oximeter-based index that reflects the partial pressure of oxygen (PaO<inf>2</inf>), could determine the amount of postoperative supplemental oxygen. We also evaluated the extent of hyperoxia and hypoxia. METHODS Fifty patients scheduled to undergo breast surgery were randomly assigned to receive ORi-based oxygen (group O) or conventional postoperative oxygen (group C) treatments. Postoperatively, patients were transported to the Post-Anesthesia Care Unit (PACU) and then to general wards. In group O, oxygen was administered at 4 L·min-1 in the operation room after extubation and was decreased if the ORi was >0.00 until a continuous index of 0.00 was achieved for 30 min in the PACU and wards. In group C, oxygen was administered at 4 L·min-1 throughout the evaluation period. BGA was performed 1 h after anesthesia induction (T0), after extubation (T1), before PACU exit (T2), and on the first postoperative morning (T3). Percutaneous oxygen saturation was measured every two seconds from 9 PM after surgery to 6 AM the next morning. RESULTS The supplemental oxygen amount and PaO<inf>2</inf> were significantly lower in group O than group C at T2 (1.5 [0.5-3.0] vs. 4.0 [4.0-4.0] L/min, 117.3 [26.8] vs. 170.0 [42.8] mmHg) and T3 (1.0 [0.5-3.0] vs. 4.0 [4.0-4.0] L/min, 107.5 [16.5] vs. 157.1 [28.4] mmHg; median [interquartile ranges] and mean [1 SD]; P<0.01). No patient exhibited hypoxia. CONCLUSIONS Based on our results, ORi might be useful to titrate postoperative oxygen supplementation.
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Affiliation(s)
- Motoi Kumagai
- Department of Anesthesiology, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan -
| | - Hiroto Kurihara
- Department of Anesthesiology, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
| | - Kazushige Ishida
- Department of Surgery, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
| | - Hideaki Komatsu
- Department of Surgery, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
| | - Kenji Suzuki
- Department of Anesthesiology, School of Medicine, Iwate Medical University Hospital, Yahaba-cho, Japan
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Abstract
The oxygen reserve index (ORI) is a new technology that provides real-time, non-invasive, and continuous monitoring of patients’ oxygenation status. This review aimed to discuss its clinical utility, prospect and limitations. A systematic literature search of PubMed, MEDLINE, Google Scholar, and ScienceDirect was performed with the keywords of “oxygen reserve index,” “ORI,” “oxygenation,” “pulse oximetry,” “monitoring,” and “hyperoxia.” Original articles, reviews, case reports, and other relevant articles were reviewed. All articles on ORI were selected. ORI can provide an early warning before saturation begins to decrease and expands the ability to monitor the human body's oxygenation status noninvasively and continuously with the combination of pulse oximetry so as to avoid unnecessary hyperoxia or unanticipated hypoxia. Although the technology is so new that it is rarely known and has not been applied to routine practices in hospitals, it shows good prospects for critical care, oxygen therapy, and intraoperative monitoring.
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Pediatric airway surgery under spontaneous respiration using high-flow nasal oxygen. Int J Pediatr Otorhinolaryngol 2020; 134:110042. [PMID: 32302883 DOI: 10.1016/j.ijporl.2020.110042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In pediatric airway surgery, SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) has not been well explored. Here, we report our experience of using STRIVE Hi in endoscopic evaluations and surgeries of the pediatric airway. METHODS This retrospective review was based on 45 airway procedures conducted under STRIVE Hi, performed by a single surgeon at a single institute from May 2017 to September 2018. After induction of anesthesia, continuous infusion with propofol and remifentanil was provided to ensure an adequate level of anesthesia and supply of humidified oxygen via a nasal cannula. Monitoring was conducted using a transcutaneous CO2 sensor and a pulse oximeter, and the oxygen reserve and bispectral indexes were measured. No muscle relaxant was administered. RESULTS The median age of the patients was 16.0 months (range: 1-215 months) and the median weight was 10.2 kg (range: 2.4-38.5 kg). The median duration of spontaneous respiration was min 40 (range: 10-140 min). The airway procedures included diagnostic microlaryngoscopy, tracheocutaneous fistula excision, balloon dilation, supraglottoplasty, laryngeal cleft repair, injection laryngoplasty, papilloma excision, and subglottic cyst removal. During these procedures, STRIVE Hi facilitated evaluation of dynamic obstruction of the airway and the immediate outcome of surgical treatment and provided a good surgical view. Intubation and the termination of spontaneous respiration were required in only five patients. CONCLUSIONS STRIVE Hi is an effective and feasible anesthesia option in pediatric airway surgery. It provides unobstructed surgical access and is applicable to a wide range of procedures.
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Abstract
PURPOSE OF REVIEW Anesthesia outside the operating room is rapidly expanding for adult and pediatric patients. Anesthesia clinicians practicing in this area need a good understanding of the challenges of the NORA environment and the anesthetic risks and perioperative implications of practice so that they can deliver safe care to their patients. RECENT FINDINGS Recent reports from large patient databases have afforded anesthesiologists a greater understanding of the risk of NORA when compared to anesthesia in the operating room. Descriptions of advances in team training with the use of simulation have allowed the development of organized procedural teams. With an emphasis on clear communication, an understanding of individual roles, and a patient-centered focus, these teams can reliably develop emergency response procedures, so that critical moments are not delayed in an environment remote from usual assistance. SUMMARY With appropriate attention to organizational concerns (i.e. team environment, safety protocols) and unrelenting focus on patient safety, anesthesiologists can assist in safely providing the benefit of cutting-edge technical advancements to pediatric patients in these challenging environments.
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Tsymbal E, Ayala S, Singh A, Applegate RL, Fleming NW. Study of early warning for desaturation provided by Oxygen Reserve Index in obese patients. J Clin Monit Comput 2020; 35:749-756. [PMID: 32424516 PMCID: PMC8286939 DOI: 10.1007/s10877-020-00531-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
Acute hemoglobin desaturation can reflect rapidly decreasing PaO2. Pulse oximetry saturation (SpO2) facilitates hypoxia detection but may not significantly decrease until PaO2 < 80 mmHg. The Oxygen Reserve Index (ORI) is a unitless index that correlates with moderately hyperoxic PaO2. This study evaluated whether ORI provides added arterial desaturation warning in obese patients. This IRB approved, prospective, observational study obtained written informed consent from Obese (body mass index (BMI) kg m-2; 30 < BMI < 40) and Normal BMI (19 < BMI < 25) adult patients scheduled for elective surgery requiring general endotracheal anesthesia. Standard monitors and an ORI sensor were placed. Patient's lungs were pre-oxygenated with 100% FiO2. After ORI plateaued, general anesthesia was induced, and endotracheal intubation accomplished using a videolaryngoscope. Patients remained apneic until SpO2reached 94%. ORI and SpO2 were recorded continuously. Added warning time was defined as the difference between the time to SpO2 94% from ORI alarm start or from SpO2 97%. Data are reported as median; 95% confidence interval. Complete data were collected in 36 Obese and 36 Normal BMI patients. ORI warning time was always longer than SpO2 warning time. Added warning time provided by ORI was 46.5 (36.0-59.0) seconds in Obese and 87.0 (77.0-109.0) seconds in Normal BMI patients, and was shorter in Obese than Normal BMI patients difference 54.0 (38.0-74.0) seconds (p < 0.0001). ORI provided what was felt to be clinically significant added warning time of arterial desaturation compared to SpO2. This added time might allow earlier calls for help, assistance from other providers, or modifications of airway management.Trial registration ClinicalTrials.gov NCT03021551.
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Affiliation(s)
- Ekaterina Tsymbal
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
| | - Sebastian Ayala
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
| | - Amrik Singh
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
| | - Richard L Applegate
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA.
| | - Neal W Fleming
- Department of Anesthesiology and Pain Medicine, University of California Davis, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
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Stein ML, Park RS, Kovatsis PG. Emerging trends, techniques, and equipment for airway management in pediatric patients. Paediatr Anaesth 2020; 30:269-279. [PMID: 32022437 DOI: 10.1111/pan.13814] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 12/21/2022]
Abstract
Pediatric patients present unique anatomic and physiologic considerations in airway management, which impose significant physiologic limits on safe apnea time before the onset of hypoxemia and subsequent bradycardia. These issues are even more pronounced for the pediatric difficult airway. In the last decade, the development of pediatric sized supraglottic airways specifically designed for intubation, as well as advances in imaging technology such that current pediatric airway equipment now finally rival those for the adult population, has significantly expanded the pediatric anesthesiologist's tool kit for pediatric airway management. Equally important, techniques are increasingly implemented that maintain oxygen delivery to the lungs, safely extending the time available for pediatric airway management. This review will focus on emerging trends and techniques using existing tools to safely handle the pediatric airway including videolaryngoscopy, combination techniques for intubation, techniques for maintaining oxygenation during intubation, airway management in patients at risk for aspiration, and considerations in cannot intubate cannot oxygenate scenarios.
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Affiliation(s)
- Mary Lyn Stein
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Raymond S Park
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Pete G Kovatsis
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Cavaliere F, Biancofiore G, Bignami E, De Robertis E, Giannini A, Grasso S, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2018. Critical care. Experimental and clinical studies. Minerva Anestesiol 2020; 85:95-105. [PMID: 30632731 DOI: 10.23736/s0375-9393.18.13524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Ospedale dei Bambini, ASST - Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grasso
- Division of Anesthesiology and Resuscitation, Department of Emergency and Organ Transplantation (DETO), Aldo Moro University of Bari, Policlinic Hospital, Bari, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, University Policlinic A. Gemelli IRCCS Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Unit of Resuscitation, Critical Care, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital, University of Sassari, Sassari, Italy
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Alday E, Nieves JM, Planas A. Oxygen Reserve Index Predicts Hypoxemia During One-Lung Ventilation: An Observational Diagnostic Study. J Cardiothorac Vasc Anesth 2020; 34:417-422. [DOI: 10.1053/j.jvca.2019.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/16/2019] [Accepted: 06/24/2019] [Indexed: 01/10/2023]
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Deguchi Y, Seki H, Tamaki H, Ouchi T. Successful Airway and Anesthesia Management Using a High-Flow Nasal Cannula in a Fibrodysplasia Ossificans Progressiva Patient During General Anesthesia: A Case Report. A A Pract 2020; 14:75-78. [PMID: 31815772 DOI: 10.1213/xaa.0000000000001152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disorder causing neck stiffness, ankylosis of temporomandibular joints, and severe restrictive respiratory dysfunction due to progressive heterotopic ossification of the connective tissue. Herein, we report a case of successful airway and anesthesia management using a high-flow nasal cannula (HFNC) in a 51-year-old man with FOP undergoing partial bone resection of the right greater trochanter of the femur. Although general anesthesia with awake fiberoptic nasotracheal intubation has been described as the gold standard, HFNC may yield another potentially viable option for patients undergoing a surgical procedure that does not involve the airway.
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Affiliation(s)
- Yoshihiko Deguchi
- From the Department of Anesthesiology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
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Dave N, Goel A, Shah H, Muneshwar P. The troublesome triumvirate: Temporomandibular joint ankylosis, Pierre Robin syndrome and severe obstructive sleep apnoea. Indian J Anaesth 2020; 64:800-803. [PMID: 33162576 PMCID: PMC7641070 DOI: 10.4103/ija.ija_741_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/26/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
Managing the paediatric airway with a multitude of issues, poses a unique anaesthetic challenge. Thorough understanding of implications of the associated co-morbidities, meticulous planning to counter the anticipated difficulties with back-up plans and optimal utilisation of modern anaesthesia techniques are the cornerstones in ensuring success in such tricky situations.
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Karnik P, Agrawal B, Dave N. Oxygen reserve index – A new paradigm in patient safety. J Anaesthesiol Clin Pharmacol 2020; 36:125-126. [PMID: 32174677 PMCID: PMC7047688 DOI: 10.4103/joacp.joacp_76_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 08/25/2019] [Indexed: 11/30/2022] Open
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Yoshida K, Isosu T, Imaizumi T, Obara S, Murakawa M. Oxygen Reserve Index (ORi TM ) as an alarm for oxygenation deterioration in pediatric tracheostomaplasty: A case report. Paediatr Anaesth 2019; 29:1151-1153. [PMID: 31677336 DOI: 10.1111/pan.13739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Isosu
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Tsuyoshi Imaizumi
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Shinju Obara
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Masahiro Murakawa
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
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Humphreys S, von Ungern-Sternberg BS, Skowno J, Williams T, Taylor J, Taverner F, Gibbons K, Burgoyne L, Sommerfield D, Stephens P, Hallett B, Vijayasekaran S, Slee N, Burns H, Sowa M, Davidson A, Schibler A. High-flow oxygen for children's airway surgery: rando mi sed controll ed trial protocol (HAMSTER). BMJ Open 2019; 9:e031873. [PMID: 31615801 PMCID: PMC6797255 DOI: 10.1136/bmjopen-2019-031873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Hypoxaemia during anaesthesia for tubeless upper airway surgery in children with abnormal airways is common due to the complexity of balancing adequate depth of anaesthesia with maintenance of spontaneous breathing and providing an uninterrupted field of view of the upper airway for the surgeon. High-flow nasal oxygenation (HIGH-FLOW) can prolong safe apnoea time and be used in children with abnormal airways but to date has not been compared with the alternative technique of low-flow nasal oxygenation (LOW-FLOW). The aim is to investigate if use of HIGH-FLOW can reduce the number of hypoxaemic events requiring rescue oxygenation compared with LOW-FLOW. METHODS AND ANALYSIS: High-flow oxygen for children's airway surgery: randomised controlled trial (HAMSTER) is a multicentre, unmasked, randomised controlled, parallel group, superiority trial comparing two oxygenation techniques during anaesthesia. Children (n=530) aged >37 weeks to 16 years presenting for elective tubeless upper airway surgery who fulfil inclusion but not exclusion criteria will be randomised prior to surgery to HIGH-FLOW or LOW-FLOW post induction of anaesthesia. Maintenance of anaesthesia with HIGH-FLOW requires Total IntraVenous Anaesthesia (TIVA) and with LOW-FLOW, either inhalational or TIVA at discretion of anaesthetist. The primary outcome is the incidence of hypoxaemic events requiring interruption of procedure for rescue oxygenation by positive pressure ventilation and the secondary outcome includes total hypoxaemia time, adverse cardiorespiratory events and unexpected paediatric intensive care admission admission. Hypoxaemia is defined as Sp02 <90%. Analysis will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethical approval has been obtained by Children's Health Queensland Human Research Ethics Committee (HREC/18/QRCH/130). The trial commenced recruitment in 2018. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER The HAMSTER is registered with the Australia and New Zealand Clinical TrialsRegistry: ACTRN12618000949280.
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Affiliation(s)
- Susan Humphreys
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Britta Sylvia von Ungern-Sternberg
- Anaesthesia, Perth Children's Hospital, Nedlands, Queensland, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | - Justin Skowno
- Department of Anaesthesia, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tara Williams
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Julia Taylor
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona Taverner
- Department of Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- University of South Australia, Adelaide, South Australia, Australia
| | - Kristen Gibbons
- Statistics, Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Laura Burgoyne
- Department of Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- University of South Australia, Adelaide, South Australia, Australia
| | - David Sommerfield
- Anaesthesia, Perth Children's Hospital, Nedlands, Queensland, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | - Philip Stephens
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ben Hallett
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Shyan Vijayasekaran
- University of Western Australia, Crawley, Western Australia, Australia
- Ear, Nose and Throat Surgery, Perth Children's Hospital, Nedlands, Queensland, Australia
| | - Nicola Slee
- Department of Surgery; Ear, Nose and Throat, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Hannah Burns
- Department of Surgery; Ear, Nose and Throat, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Marcin Sowa
- Health Economics, The University of Queensland, South Brisbane, Queensland, Australia
| | - Andrew Davidson
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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