Commentary: A Multicenter, Randomized, Controlled Phase IIb Trial of Avoidance of Hyperoxemia during Cardiopulmonary Bypass
Authors: Shahzad Shaefi, M.D. et al
Anesthesiology 9 2016, Vol.125, 449-450.
THERE are approximately 300,000 cardiac surgical procedures annually utilizing cardiopulmonary bypass (CPB) in the United States. The delivery of oxygen has been a cornerstone of anesthesia practice, with titration of oxygen therapy to ensure avoidance of potentially injurious periods of hypoxemia. However, the same attention has not been afforded for levels of relativehyperoxemia, mostly due to the assumption that excess oxygen is relatively harmless. Emerging clinical data within a variety of arenas suggest that this assumption may not be true. There appears to be potentially deleterious effects from hyperoxemia, whether it be demonstration of extension of infarct size postmyocardial infarction or worse neurologic outcomes and higher mortality in patients receiving therapeutic hypothermia following return of spontaneous circulation after cardiac arrest. Given these data, there has been rekindled interest in the conceivably detrimental consequences of hyperoxemia in the domain of CPB during cardiac surgery where ischemia–reperfusion injury may lead to an increased susceptibility to formation of reactive oxygen species. In this issue of Anesthesiology, McGuinness et al. investigate the avoidance of hyperoxemia during CPB on postoperative acute kidney injury in cardiac surgery.