Ayten SARAÇOĞLU, Zeynep Zuhal AYKAÇ, Bedrettin YILDIZELİ, Esra YAMANSAVCI ŞİRZAİ, Mustafa YÜKSEL

Oxygen reserve index guided oxygen titration in one lung ventilation with low fresh gas flow

Background/aim: Continuous oxygen reserve index (ORI) measurement with multiple wave pulse co-oximetry is a noninvasive measurement. The decrease in the ORI trend provides a prediction for the development of hypoxemia and provides information on hyperoxia. Our aim is to determine the effect of ORI-guided oxygen titration on hyperoxemia-mediated morbidity. Materials and methods: Consecutive 120 ASA I-III patients, 18–70 years of age, without severe obstruction or restriction, undergoing one lung ventilation (OLV), were included in the study. Patients were divided into 4 groups. Oxygen titration without ORI monitoring with low-flow anesthesia (1 L/min, Group 1, n = 25) and high-flow anesthesia (4 L/min, Group 2, n = 28). Oxygen titration by ORI monitoring with low flow anesthesia (1 L/min, Group 3, n = 25) and high flow anesthesia (4 L/min, Group 4, n = 25). FiO2 increased up to 100% if necessary. OLV time, duration of surgery and anesthesia, FiO2 applied during OLV, oxygen application time (T) over 60%, vital signs, hospital and ICU stay time, and complications were recorded. Results: There was a statistically significant difference in terms of FiO2 used during OLV (p < 0.05). There was no difference in ORI values (p < 0.05). In Group 3, both PaO2 and SpO2 were significantly lower than the others both before and during OLV. There was no significant difference in terms of ORI parameters between low flow and high flow anesthesia groups. There was a strong, positive correlation between the duration of hospital stay and FiO2 used above 80% during OLV. Conclusion: We concluded that ORI-guided thoracic anesthesia may reduce hospital stay and increase patient safety.Key words: Oxygen reserve index, thoracic surgery, one lung ventilation, low flow anesthesia

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1. Vos JJ, Willems CH, Van Amsterdam K, Van den Berg JP, Spanjersberg R et al. Oxygen reserve index: validation of a new variable. Anesthesia and Analgesia 2019; 129 (2): 409-415. doi: 10.1213/ANE.0000000000003706
2. Lasocki S, Brochant A, Leger M, Gaillard T, Lemarié P et al. ORI monitoring allows a reduction of time with hyperoxia in critically ill patients: the randomized control ORI2 study. Intensive Care Medicine 2019; 45 (11): 1661-1662. doi: 10.1007/s00134-019-05732-9
3. Damiani E, Donati A, Girardis M. Oxygen in the critically ill: friend or foe? Current Opinion in Anaesthesiology 2018; 31 (2): 129-135. doi: 10.1097/ACO.0000000000000559
4. Helmerhorst HJ, Schultz MJ, Van der Voort PH, De Jonge E, Van Westerloo DJ. Bench-to-bedside review: the effects of hyperoxia during critical illness. Critical Care 2015; 19 (1): 284. doi: 10.1186/s13054-015-0996-4
5. Campos JH, Feider A. Hypoxia during one-lung ventilation-a review and update. Journal of Cardiothoracic and Vascular Anesthesia 2018; 32: 2330-2338. doi: 10.1053/j.jvca.2017.12.026
6. De la Gala F, Piñeiro P, Reyes A, Vara E, Olmedilla L et al. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. British Journal of Anaesthesia 2017; 119 (4): 655-663. doi: 10.1093/bja/aex230
7. Karzai W, Schwarzkopf K. Hypoxemia during onelung ventilation: prediction, prevention, and treatment. Anesthesiology 2009; 110 (6): 1402-1411. doi: 10.1097/ALN.0b013e31819fb15d
8. Olivant Fisher A, Husain K, Wolfson MR, Hubert TL, Rodriguez E et al. Hyperoxia during one lung ventilation: inflammatory and oxidative responses. Pediatric Pulmonology 2012; 47 (10): 979-986. doi: 10.1002/ppul.22517
9. Alday E, Nieves JM, Planas A. Oxygen reserve index predicts hypoxemia during onelung ventilation: an observational diagnostic study. Journal of Cardiothoracic and Vascular Anesthesia 2020; 34 (2): 417-422. doi: 10.1053/j.jvca.2019.06.035
10. Campos JH, Sharma A. Predictors of hypoxemia during onelung ventilation in thoracic surgery: is oxygen reserve index (ORI) the answer? Journal of Cardiothoracic and Vascular Anesthesia 2020; 34 (2): 423-425. doi: 10.1053/j.jvca.2019.06.035
11. Koishi W, Kumagai M, Ogawa S, Hongo S, Suzuki K. Monitoring the oxygen reserve index can contribute to the early detection of deterioration in blood oxygenation during one-lung ventilation. Minerva Anestesiologica 2018; 84 (9): 1063-1069. doi: 10.23736/S0375-9393.18.12622-8
12. Applegate RL 2nd, Dorotta IL, Wells B, Juma D, Applegate PM. The relationship between oxygen reserve index and arterial partial pressure of oxygen during surgery. Anesthesia and Analgesia 2016; 123 (3): 626-633. doi: 10.1213/ANE.0000000000001262
13. Blank RS, Colquhoun DA, Durieux ME, Kozower BD, McMurry TL et al. Management of one-lung ventilation: impact of tidal volume on complications after thoracic surgery. Anesthesiology 2016; 124 (6): 1286-1295. doi: 10.1097/ALN.0000000000001100